Individual
MR. RAMESH REDDY KEESARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
187 W MAIN ST, DECATURVILLE, TN 38329
(731) 852-2761
(731) 852-2781
Mailing address
187 W MAIN ST, PO BOX 127, DECATURVILLE, TN 38329
(731) 852-2761
(731) 852-2781
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12891
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001364
BCBS OF TN PIN
TN
05
—
3183218
—
TN
Enumeration date
05/19/2006
Last updated
03/20/2013
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