RAO PRASAD IMMANENI M.D. NPI 1720196520

NPI Information

NPI: 1720196520
Provider Name: RAO PRASAD IMMANENI, M.D.
Classification: Pediatrics - 208000000X
Entity Type: Individual
Address:
1230 BRAMPTON AVE
STATESBORO, GA
ZIP 30458
Phone: (912) 489-5437
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Rao Prasad Immaneni, M.D. is a pediatrics in Statesboro, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Rao Prasad Immaneni, M.D. NPI is 1720196520. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1230 BRAMPTON AVE
STATESBORO, GA
ZIP 30458-849
Phone: (912) 489-5437
Fax: (912) 489-5550

The enumeration date for this NPI number is 8/29/2006 and was last updated on 5/11/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208000000X	Pediatrics		044756	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	000798377A	OTHER	GEORGIA	PEACH STATE ID
2	37BBGKV	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	INDIVIDUAL MEDICARE ID
3	336225	OTHER	GEORGIA	WELLCARE
4	598970	OTHER	GEORGIA	BLUE CROSS BLUE SHIELD
5	0007241193	OTHER	GEORGIA	AETNA
6	1917290	OTHER	GEORGIA	CCN/FIRST HEALTH
7	000798377A	MEDICAID	GEORGIA
8	10057735	OTHER	GEORGIA	AMERIGROUP PROVIDER ID
9	GRP3032	MEDICARE ID-TYPE UNSPECIFIED	GEORGIA	MEDICARE GROUP #
10	2263921	OTHER	GEORGIA	UNITED HEALTH CARE
11	5261615	OTHER	GEORGIA	CIGNA
12	H80570	MEDICARE UPIN	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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