Individual
BANNUR RAMANNA NANDEESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 475-5076
Mailing address
1199 PRINCE AVE STE 70, ATHENS, GA 30606-2797
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
89427
GA
208M00000X
Hospitalist Physician
Primary
89427
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2018
Last updated
08/25/2021
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