Provider Demographics
NPI:1669177994
Name:PINGALI, RAGHAVENDRA
Entity type:Individual
Prefix:
First Name:RAGHAVENDRA
Middle Name:
Last Name:PINGALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 CORDURY TER
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1965
Mailing Address - Country:US
Mailing Address - Phone:770-329-0979
Mailing Address - Fax:
Practice Address - Street 1:2945 CORDURY TER
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1965
Practice Address - Country:US
Practice Address - Phone:770-329-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program