Healthcare Provider Details

I. General information

NPI: 1841722394
Provider Name (Legal Business Name): ABHILASH GUDURU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W END AVE STE 1150
NASHVILLE TN
37203-2528
US

IV. Provider business mailing address

1801 W END AVE STE 1150
NASHVILLE TN
37203-2528
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-8881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number65665
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: