Revathi Nagabhairu Koneru, M.D

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

224949 Issued in NY

Practice address

1826 Veterans Blvd
Dublin, GA 31021-3620

Phone

(478) 272-1210

NPI assigned

May 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Revathi Nagabhairu Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Personal Recovery Network LLC

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869
  Medicare reassignment NPD
• Georgia Department of Human Resources

  • Psychiatric Hospital
  • Columbus, GA
  • NPI 1144224767
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184284800000",
    "number": "1023060266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1826 VETERANS BLVD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310213620",
            "telephone_number": "478-272-1210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1826 VETERANS BLVD",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310213620",
            "telephone_number": "478-272-1210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONERU",
        "first_name": "REVATHI",
        "middle_name": "NAGABHAIRU",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2007-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "224949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REVATHI",
            "last_name": "NAGABHAIRU",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dana Michelle Knight, NP-C
• Danielle Katelyn Knight, OTD
• Kelly Young Knight, NURSE PRACTITIONER
• Benjamin Knowles, RPH,PHARMD
• Kirkland Bain Kolbie, M.D.
• Michelle Suzanne Kotcella, MSN,FNPC
• Collins A Kwarteng, MD
• L M Bass LLC
• L M Bass LLC
• Dorothy Ladson

• Psychiatry Physician in Dublin, GA
• Providers in Dublin, GA by specialty
• Psychiatry Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.