Individual
SUBBA R GOLLAMUDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9411
(901) 685-2200
(901) 820-2342
Mailing address
PO BOX 22510, JACKSON, MS 39225-2510
(901) 685-2200
(901) 255-5631
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
16734
MS
207W00000X
Ophthalmology Physician
E-3527
AR
207W00000X
Ophthalmology Physician
Primary
MD0000021892
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00119845
—
MS
05
—
121686001
—
AR
01
—
180018881
PALMETTO RR MEDICARE
TN
01
—
180042504
PALMETTO RR MEDICARE
MS
05
—
3067983
—
TN
Enumeration date
05/28/2006
Last updated
07/25/2022
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