Provider Demographics
NPI:1023040524
Name:TANGUTURI, SRIHARSHA S (MD)
Entity type:Individual
Prefix:DR
First Name:SRIHARSHA
Middle Name:S
Last Name:TANGUTURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HARSHA
Other - Middle Name:S
Other - Last Name:TANGUTURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1300 RIDENOUR BLVD NW STE 300
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-4402
Mailing Address - Country:US
Mailing Address - Phone:770-702-1806
Mailing Address - Fax:
Practice Address - Street 1:2306 WISTERIA DR STE 100
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3561
Practice Address - Country:US
Practice Address - Phone:770-979-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALI41709Medicare UPIN
AL051556703Medicare ID - Type Unspecified