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Individual
RAO PRASAD IMMANENI
Active
Individual
RAO PRASAD IMMANENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
044756
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007241193
AETNA
GA
01
—
000798377A
PEACH STATE ID
GA
05
—
000798377A
—
GA
01
—
10057735
AMERIGROUP PROVIDER ID
GA
01
—
1917290
CCN/FIRST HEALTH
GA
01
—
2263921
UNITED HEALTH CARE
GA
01
—
336225
WELLCARE
GA
01
—
5261615
CIGNA
GA
01
—
598970
BLUE CROSS BLUE SHIELD
GA
Enumeration date
08/29/2006
Last updated
05/11/2009
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