Healthcare Provider Details

I. General information

NPI: 1821217852
Provider Name (Legal Business Name): HARISH VEERAMACHANENI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JV MANGUBAT DR
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

854 W JAMES CAMPBELL BLVD SUITE 303
COLUMBIA TN
38401-4659
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-9999
  • Fax: 931-722-2049
Mailing address:
  • Phone: 931-722-9999
  • Fax: 931-722-2049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.092484
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46017
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: