=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750548566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TULASI R. VANAPALLI, M. D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 MOUNT ZION RD SUITE J
-----------------------------------------------------
City | MORROW
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30260-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-968-7421
-----------------------------------------------------
Fax | 770-960-0078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 MOUNT ZION RD SUITE J
-----------------------------------------------------
City | MORROW
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30260-2266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-968-7421
-----------------------------------------------------
Fax | 770-960-0078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. TULASI R. VANAPALLI
-----------------------------------------------------
Credential | M. D.
-----------------------------------------------------
Telephone | 770-968-7421
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 024504
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------