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General NPI Number Information
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NPI Number | 1689651770
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Entity Type | Individual
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Provider Name | RAVINDRA EDUPUGANTI M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 55 WHITCHER ST NE SUITE 350
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City | MARIETTA
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State | GA
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Zip | 30060-1155
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Country | US
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Telephone | 770-424-6893
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Fax | 678-819-0357
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Provider Business Mailing Address
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Address Line | 55 WHITCHER ST NE STE 350
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City | MARIETTA
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State | GA
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Zip | 30060-1129
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Country | US
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Telephone | 770-424-6893
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Fax | 770-424-9095
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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 | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 063858
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 063858
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 063858
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License Number State | GA
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