=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215244850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | R.V. DRONAVALLI, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2010
-----------------------------------------------------
Last Update Date | 09/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2138 SCENIC HWY N SUITE A
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-979-0877
-----------------------------------------------------
Fax | 770-979-4553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2138 SCENIC HWY N SUITE A
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-979-0877
-----------------------------------------------------
Fax | 770-979-4553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. KAY DRONAVALLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-979-0877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 18641
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------