Basic Information
| Provider Information | |||||||||
| NPI: | 1982829297 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NARRA | ||||||||
| FirstName: | KANTHI CHARAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 W JAMES CAMPBELL BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384014659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313790019 | ||||||||
| FaxNumber: | 9313797381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1090 N ELLINGTON PKWY | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | LEWISBURG | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370912227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313590019 | ||||||||
| FaxNumber: | 9313597381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 05/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QH0002X | 4301088652 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | 46122 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QG0300X | 46122 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3710089 | 05 | TN | MEDICAID |