Healthcare Provider Details

I. General information

NPI: 1265538581
Provider Name (Legal Business Name): PRASAD V KONDAPAVULURU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N MAPLE STREET STE 4
MURFREESBORO TN
37130-3524
US

IV. Provider business mailing address

105 N MAPLE STREET STE 4
MURFREESBORO TN
37130-3524
US

V. Phone/Fax

Practice location:
  • Phone: 615-716-8255
  • Fax: 615-893-9969
Mailing address:
  • Phone: 615-716-8255
  • Fax: 615-893-9969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD0000029704
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: