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NPI Code Detail

MEDICARE: DR. PRAVEEN MANNAM M.D

MEDICARE: DR. PRAVEEN MANNAM 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
1207RP1001XPulmonary Disease Physician2016-00544NC
2207RC0200XCritical Care Medicine (Internal Medicine) Physician2016-00544NC

General Provider Information

NPI Number : 1316113897
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRAVEEN MANNAM M.D
Provider Business Mailing Address
First Line : PO BOX 745040
Second Line :
City : ATLANTA
State : GA
Zip : 30374-5040
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3511 W MARKET ST STE 100
Second Line :
City : GREENSBORO
State : NC
Zip : 27403-4444
Country : US
Telephone Number : 336-522-8999
Fax Number : 336-522-8998
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2008
Last Update Date : 12/10/2024

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Directions to “ DR. PRAVEEN MANNAM M.D” Practice Location

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