Individual
MR. SWATANTRA BABU KODALI
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1104 W 4TH NORTH ST, MORRISTOWN, TN 37814
(423) 317-8482
(423) 317-9901
Mailing address
1104 W 4TH NORTH ST, MORRISTOWN, TN 37814
(423) 317-8482
(423) 317-9901
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD20092
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3855409
—
TN
01
—
4000766
BLUE CROSS
—
Enumeration date
08/09/2005
Last updated
07/08/2007
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