Basic Information
| Provider Information | |||||||||
| NPI: | 1942556568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNDARAGIRI | ||||||||
| FirstName: | PRANATHI | ||||||||
| MiddleName: | RAO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MBBS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1395 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331695710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706293217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1331 MOUNT ZION RD | ||||||||
| Address2: | |||||||||
| City: | MORROW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302602357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706293217 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2012 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 59269 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 59269 | MN | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 85408 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.