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General NPI Number Information
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NPI Number | 1891137485
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Entity Type | Individual
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Provider Name | GOWTHAM ROY LINGAMANENI M.D
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Gender | Male
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Dates
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Enumeration Date | 07/23/2013
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 1325 EASTMORELAND AVE STE 310
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City | MEMPHIS
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State | TN
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Zip | 38104-7544
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Country | US
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Telephone | 901-758-7970
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Fax | 901-266-6425
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 330
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City | MEMPHIS
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State | TN
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Zip | 38104-6655
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Country | US
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Telephone |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101267383
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License Number State | VA
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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 | 29019
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License Number State | WV
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 72509
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License Number State | TN
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