Provider Demographics
NPI:1306956586
Name:KRISHNAN, KARTHIK R (MD)
Entity type:Individual
Prefix:
First Name:KARTHIK
Middle Name:R
Last Name:KRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 W LAMAR ALEXANDER PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3904
Mailing Address - Country:US
Mailing Address - Phone:865-273-0008
Mailing Address - Fax:658-954-0908
Practice Address - Street 1:616 W LAMAR ALEXANDER PKWY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3904
Practice Address - Country:US
Practice Address - Phone:865-273-0008
Practice Address - Fax:658-954-0908
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46000174400000X
GA053320208000000X
TNMD46000207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA937817286AMedicaid
SCG53320Medicaid
TN103I030023Medicare PIN
SCG53320Medicaid