Provider Demographics
NPI:1265693543
Name:RAVINDRANATHA MENON, PRAHARSHA (MD)
Entity type:Individual
Prefix:
First Name:PRAHARSHA
Middle Name:
Last Name:RAVINDRANATHA MENON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRAHARSHA
Other - Middle Name:
Other - Last Name:RAVINDRANATHA MENON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2084 HEADLAND DR
Mailing Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER EASY POINT, LLC
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2135
Mailing Address - Country:US
Mailing Address - Phone:404-965-5691
Mailing Address - Fax:404-965-5710
Practice Address - Street 1:2084 HEADLAND DR
Practice Address - Street 2:JENCARE NEIGHBORHOOD MEDICAL CENTER EAST POINT, LLC
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-2135
Practice Address - Country:US
Practice Address - Phone:404-965-5691
Practice Address - Fax:404-965-5710
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine