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General NPI Number Information
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NPI Number | 1427071380
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Entity Type | Organization
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Legal Business Name | SARATH B GANGAVARAPU MD PC
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2765 EXECUTIVE PARK DR NW STE 1
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City | CLEVELAND
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State | TN
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Zip | 37312
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Country | US
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Telephone | 423-559-8989
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Fax | 423-559-8984
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Provider Business Mailing Address
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Address Line | PO BOX 4816
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City | CLEVELAND
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State | TN
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Zip | 37320
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Country | US
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Telephone | 423-559-8989
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Fax | 423-559-8984
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Authorized Official
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Title or Position | MEDICAL
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Name | SARATH B GANGAVARAPU
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Credential | MD
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Telephone | 423-559-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD0000016350
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License Number State | TN
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