MEDICARE: DR. SUMALATHA MANNAVA 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	207R00000X	Internal Medicine Physician	25MA07699000	NJ
2	207R00000X	Internal Medicine Physician	64736	AZ

General Provider Information

NPI Number	:	1477583235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUMALATHA MANNAVA M.D.,

Provider Business Mailing Address
First Line	:	PO BOX 746093
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6093
Country	:	US
Telephone Number	:	602-671-7068
Fax Number	:	602-671-6946

Provider Business Practice Location Address
First Line	:	5110 W MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-3862
Country	:	US
Telephone Number	:	602-671-7068
Fax Number	:	602-671-6946

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	05/13/2026

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