Healthcare Provider Details

I. General information

NPI: 1912107483
Provider Name (Legal Business Name): NAGESWARA RAO CHUNDURU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

528 N UNIVERSITY ST
MURFREESBORO TN
37130-3012
US

IV. Provider business mailing address

528 N UNIVERSITY ST
MURFREESBORO TN
37130-3012
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-3780
  • Fax: 615-867-3786
Mailing address:
  • Phone: 615-867-3780
  • Fax: 615-867-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAGESWARA RAO CHUNDURU
Title or Position: PRESIDENT
Credential: MD
Phone: 615-867-3780