Provider Demographics
NPI:1316058399
Name:INDIRADEVI, AYYAGARI (MD)
Entity type:Individual
Prefix:MRS
First Name:AYYAGARI
Middle Name:
Last Name:INDIRADEVI
Suffix:
Gender:F
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:PO BOX 341065
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38184-1065
Mailing Address - Country:US
Mailing Address - Phone:901-385-2342
Mailing Address - Fax:901-382-0140
Practice Address - Street 1:6911 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2111
Practice Address - Country:US
Practice Address - Phone:901-461-1162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAI111192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00015928Medicaid
B04717Medicare UPIN