Healthcare Provider Details

I. General information

NPI: 1427158716
Provider Name (Legal Business Name): VENKATRAM NETHALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 WAYNE RD
SAVANNAH TN
38372-1904
US

IV. Provider business mailing address

935 WAYNE RD
SAVANNAH TN
38372-1904
US

V. Phone/Fax

Practice location:
  • Phone: 731-926-8000
  • Fax:
Mailing address:
  • Phone: 731-926-8000
  • Fax: 731-926-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8994
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberTD101035
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number018751
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: