Individual
PAVAN TUMMALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1315 JESSE JEWELL PKWY NE STE 300, GAINESVILLE, GA 30501-3875
(770) 219-6520
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
2016026000
MO
2084N0400X
Neurology Physician
Primary
96271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407111313
—
MO
05
—
200028679
—
MO
Enumeration date
07/06/2012
Last updated
10/18/2023
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