Individual
CHANDRA KUMAR MALLIC KODAVANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1108 ROSS CLARK CIR, DOTHAN, AL 36301-3022
(334) 703-8836
(334) 712-3512
Mailing address
PO BOX 1928, DOTHAN, AL 36302-1928
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
MD.46417
AL
390200000X
Student in an Organized Health Care Education/Training Program
BP10060414
TX
390200000X
Student in an Organized Health Care Education/Training Program
RS2020-0463
NM
Other
Enumeration date
07/05/2017
Last updated
07/25/2023
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