MEDICARE: JANARDHANA RAO JONNALAGADDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	2005-01663	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053351015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANARDHANA RAO JONNALAGADDA M.D.

Provider Business Mailing Address
First Line	:	2016 NEW GARDEN RD
Second Line	:	SUITE C
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2497
Country	:	US
Telephone Number	:	336-541-8111
Fax Number	:	855-427-6593

Provider Business Practice Location Address
First Line	:	2016 NEW GARDEN RD
Second Line	:	SUITE C
City	:	GREENSBORO
State	:	NC
Zip	:	27410-2497
Country	:	US
Telephone Number	:	336-541-8111
Fax Number	:	855-427-6593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/07/2015

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