Healthcare Provider Details

I. General information

NPI: 1023627015
Provider Name (Legal Business Name): RAMYA HEGDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 MIDDLE CREEK RD STE 1
SEVIERVILLE TN
37862-5017
US

IV. Provider business mailing address

216 W HERON ST
ABERDEEN WA
98520-6225
US

V. Phone/Fax

Practice location:
  • Phone: 865-622-9144
  • Fax:
Mailing address:
  • Phone: 360-532-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61078397
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12744
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: