| Organization Name: | PURNACHANDRA R YERNENI MD |
| NPI Number: | 1073777843 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PURNACHANDRA R YERNENI (OWNER/PRESIDENT) |
| Mailing Address: | 1011 Avenue F Bogalusa |
| State: | LA US |
| Postal Code: | 704274334 |
| Phone Number: | 9857329930 |
| Fax Number: | 9857329884 |
| NPI Enumeration Date: | 07/10/2008 |
| NPI Last Update Date: | 07/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 10096R |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |