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General NPI Number Information
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NPI Number | 1548709991
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Entity Type | Individual
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Provider Name | PALLAVI ANNAMANENI P.A
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Gender | Female
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/17/2017
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Provider Practice Location Address
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Address Line | 2149 VALLEYGATE DR STE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3666
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Country | US
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Telephone | 910-321-9500
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 MUIRFIELD AVE
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-3018
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Country | US
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Telephone | 910-578-2541
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-07004
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License Number State | NC
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