Provider Demographics
NPI:1124248133
Name:GERMANTOWN INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:GERMANTOWN INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:YALAMANCHILLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-537-1892
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 829
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0829
Mailing Address - Country:US
Mailing Address - Phone:901-537-1892
Mailing Address - Fax:901-537-1898
Practice Address - Street 1:6027 WALNUT GROVE RD - MEDICAL PLAZA 2
Practice Address - Street 2:SUITE 114
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120
Practice Address - Country:US
Practice Address - Phone:901-537-1892
Practice Address - Fax:901-537-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI27927Medicare UPIN
TN30001571Medicare PIN