Individual
PRADEEP KUMAR VAITLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5065
(601) 984-2962
Mailing address
2500 NORTH STATE STREET, JACKSON, MS 39216-4500
(601) 984-5065
(601) 984-2962
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
24433
MS
207RN0300X
Nephrology Physician
MD.206335
LA
Other
Enumeration date
07/30/2010
Last updated
07/02/2019
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