# SOUTHSIDE PHYSICIANS FOR WOMEN, LLC

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

## Provider details

- **NPI number:** 1811193055
- **Authorized official:** DR. KRISHNA RAO KUDARAVALLI M.D. (OWNER)
- **Authorized official phone:** (804) 862-3455

## Contact information

- **Practice address:** 510 S SYCAMORE ST, SUITE A & B, PETERSBURG, VA 23803-5044
- **Practice address phone:** (804) 862-3455
- **Practice address fax:** (804) 862-1439
- **Mailing address:** 510 S SYCAMORE ST, SUITE A & B, PETERSBURG, VA 23803-5044
- **Mailing address phone:** (804) 862-3455
- **Mailing address fax:** (804) 862-1439

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/25/2007
- **Last updated:** 11/13/2007