Individual
AJAY VONGALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1000
(601) 974-6241
Mailing address
1225 N STATE ST, JACKSON, MS 39202-2064
(601) 968-1000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23970
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009621593
—
MS
Enumeration date
06/29/2012
Last updated
12/22/2022
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