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General NPI Number Information
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NPI Number | 1730969122
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Entity Type | Organization
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Legal Business Name | PRANA PULMONARY CLINIC PLLC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 02/16/2024
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Provider Practice Location Address
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Address Line | 230 BOWMAN ST STE B
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City | MORRISTOWN
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State | TN
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Zip | 37813-3871
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Country | US
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Telephone | 423-501-7241
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Fax | 423-501-7242
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Provider Business Mailing Address
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Address Line | 4069 WELLINGTON BLVD
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City | MORRISTOWN
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State | TN
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Zip | 37814-1697
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Country | US
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Telephone | 865-310-2504
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DR. VIJOYDEEP TANJORE VENKOBA RAO
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Credential | MD
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Telephone | 865-310-2504
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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