MEDICARE: VEERA PAVULURI MD

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	207Q00000X	Family Medicine Physician	4301091402	MI
2	207R00000X	Internal Medicine Physician	4301091402	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00678941	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1034159	OTHER	MI	MCLAREN
2	01012510	OTHER	MI	HEALTHPLUS COMMERCIAL
3	1105910542	OTHER	MI	BCBSM
5	1037015	OTHER	MI	MCLAREN
6	200000017905	OTHER	MI	PHP COMMERCIAL

General Provider Information

NPI Number	:	1255504098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VEERA PAVULURI MD

Provider Business Mailing Address
First Line	:	132 MADISON NORTH DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-7626
Country	:	US
Telephone Number	:	973-204-9230
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 MADISON NORTH DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-7626
Country	:	US
Telephone Number	:	973-204-9230
Fax Number	:

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

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	01/17/2019

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Directions to “ VEERA PAVULURI MD” Practice Location

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