Provider Demographics
NPI:1053351015
Name:JONNALAGADDA, JANARDHANA RAO (MD)
Entity type:Individual
Prefix:
First Name:JANARDHANA
Middle Name:RAO
Last Name:JONNALAGADDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2016 NEW GARDEN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2497
Mailing Address - Country:US
Mailing Address - Phone:336-541-8111
Mailing Address - Fax:855-427-6593
Practice Address - Street 1:2016 NEW GARDEN RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2497
Practice Address - Country:US
Practice Address - Phone:336-541-8111
Practice Address - Fax:855-427-6593
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-016632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902239Medicaid