Individual
JYOTHIPRASANNA TUMMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1026 GOODYEAR AVE, STE 100, GADSDEN, AL 35903-1194
(256) 492-8250
(256) 492-8271
Mailing address
1026 GOODYEAR AVE, STE 100, GADSDEN, AL 35903-1194
(256) 492-8250
(256) 492-8271
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.29810
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115526
—
AL
01
—
116801
MEDICAID - LOCATION:851 GOODYEAR AVE, GADSDEN, AL 35903-1133
AL
01
—
MD.29810
MD LICENSE
AL
Enumeration date
09/20/2006
Last updated
10/01/2020
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