Basic Information
| Provider Information | |||||||||
| NPI: | 1720116494 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TALAPANENI | ||||||||
| FirstName: | JYOTSNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 PHILIP BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708225560 | ||||||||
| FaxNumber: | 7708224989 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 PHILIP BLVD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468745 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708225560 | ||||||||
| FaxNumber: | 7708224989 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 02/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0-604-569-4 | KS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | BT7445403 | 01 | KS | DEA # | OTHER | BT7445403 | 01 | GA | DEA | OTHER | 0-604-569-4 | 01 | KS | ECFMG # | OTHER |