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General NPI Number Information
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NPI Number | 1649276437
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Entity Type | Individual
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Provider Name | PRABHAKAR PISIPATI MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2005
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 1075 JESSE JEWELL PKWY NE STE A
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City | GAINESVILLE
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State | GA
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Zip | 30501-3814
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Country | US
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Telephone | 770-219-5407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 862
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City | CLINTON
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State | IA
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Zip | 52733-0862
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Country | US
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Telephone | 563-219-0695
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Fax | 563-519-1444
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 4301061688
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 30143
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 79002
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License Number State | GA
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