Organization
NEOGERIATRICS
Active
Other names
NOVUS HEALTH AND WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
JYOTHI DYAVANAPALLI GUDLA MD (PRESIDENT)
(330) 830-8666
Entity
Organization
Contact information
Practice address
4808 MUNSON ST NW, CANTON, OH 44718
(330) 830-8666
(330) 832-3499
Mailing address
4808 MUNSON ST NW, CANTON, OH 44718-3613
(330) 830-8666
(330) 832-3499
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
35-083145
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2940956
—
OH
Enumeration date
08/03/2009
Last updated
11/19/2024
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