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General NPI Number Information
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NPI Number | 1891760989
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Entity Type | Individual
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Provider Name | PRABHU K POTLURI M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2341 MCCALLIE AVE SUITE 402
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3239
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Country | US
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Telephone | 423-698-3309
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Fax | 423-624-6355
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Provider Business Mailing Address
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Address Line | PO BOX 3549
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City | CHATTANOOGA
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State | TN
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Zip | 37404-0549
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Country | US
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Telephone | 423-698-3309
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Fax | 423-624-6355
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD30424
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD45589
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License Number State | GA
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