Individual
GOWDHAMI MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
785 OHIO AVE STE 3E, CLARKSDALE, MS 38614-6215
(662) 351-0702
(662) 351-0703
Mailing address
785 OHIO AVE STE 3E, CLARKSDALE, MS 38614-6215
(662) 351-0702
(662) 351-0703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
17935
SC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
17935
SC
207RP1001X
Pulmonary Disease Physician
17935
SC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
17935
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
050001919C
—
GA
05
—
200011416
—
MS
01
—
8607
MEDICARE GROUP NUMBER
SC
01
—
P00944908
RR MEDICARE
SC
05
—
T20901
—
SC
Enumeration date
06/09/2005
Last updated
08/07/2024
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