# JETTY PSYCHIATRIC SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750576815
- **Authorized official:** DR. PRAVEEN JETTY M.D. (OWNER/M.D.)
- **Authorized official phone:** (205) 785-2000

## Contact information

- **Practice address:** 401 TUSCALOOSA AVE SW, SUITE 110, BIRMINGHAM, AL 35211-1416
- **Practice address phone:** (205) 785-2000
- **Practice address fax:** (205) 785-2945
- **Mailing address:** PO BOX 382664, BIRMINGHAM, AL 35238-2664
- **Mailing address phone:** (205) 785-2000
- **Mailing address fax:** (205) 785-2954

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0805X | Geriatric Psychiatry Physician | — | NULL | Yes |
| 2084P0805X | Geriatric Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/12/2007
- **Last updated:** 09/12/2007