MEDICARE: SUNEETHA S NUTHALAPATY 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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	MD40108	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114935	OTHER	TN	HEALTHSPRING
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4109701	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508899246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNEETHA S NUTHALAPATY MD

Provider Business Mailing Address
First Line	:	6290 MANCHESTER HWY
Second Line	:
City	:	MORRISON
State	:	TN
Zip	:	37357-7589
Country	:	US
Telephone Number	:	931-815-1616
Fax Number	:	931-815-1717

Provider Business Practice Location Address
First Line	:	6290 MANCHESTER HWY
Second Line	:
City	:	MORRISON
State	:	TN
Zip	:	37357-7589
Country	:	US
Telephone Number	:	931-815-1616
Fax Number	:	931-815-1717

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/13/2015

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