MEDICARE: DR. PRANATHI KONDAPANENI 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	2084N0400X	Neurology Physician	4301077824	MI
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	59447	GA

General Provider Information

NPI Number	:	1922022193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRANATHI KONDAPANENI M.D.

Provider Business Mailing Address
First Line	:	100 KIMBALL PL STE 100
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30009-2614
Country	:	US
Telephone Number	:	678-990-3962
Fax Number	:	678-840-3777

Provider Business Practice Location Address
First Line	:	4245 JOHNS CREEK PKWY STE A
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-9122
Country	:	US
Telephone Number	:	678-990-3962
Fax Number	:	678-840-3777

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	03/28/2023

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