Provider Demographics
NPI:1316052418
Name:DAMMANNA, RAVISHANKER R (MD)
Entity type:Individual
Prefix:DR
First Name:RAVISHANKER
Middle Name:R
Last Name:DAMMANNA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3333 OLD MILTON PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4437
Mailing Address - Country:US
Mailing Address - Phone:770-391-3979
Mailing Address - Fax:770-391-0020
Practice Address - Street 1:3333 OLD MILTON PKWY STE 400
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4437
Practice Address - Country:US
Practice Address - Phone:770-391-3979
Practice Address - Fax:770-391-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
GA058663207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA072558589AMedicaid
GA058663OtherGEORGIA COMPOSITE BOARD OF MEDICAL EXAMINERS
BD8632805OtherDEA NUMBER