Provider Demographics
NPI:1861586109
Name:BALJEPALLY, GAYATHRI D (MD)
Entity type:Individual
Prefix:
First Name:GAYATHRI
Middle Name:D
Last Name:BALJEPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GAYATHRI
Other - Middle Name:
Other - Last Name:KUCHIBOTLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 440165
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0165
Mailing Address - Country:US
Mailing Address - Phone:865-544-2800
Mailing Address - Fax:865-544-6812
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:STE E 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-544-2800
Practice Address - Fax:865-544-6812
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006266Medicaid
TNQ006266Medicaid
TN103I062738Medicare PIN