Individual
DR. NITHYANANDA PAKKALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
630 NUCKOLLS RD, BOLIVAR, TN 38008-1532
(731) 658-6011
(731) 658-9884
Mailing address
630 NUCKOLLS RD, BOLIVAR, TN 38008-1532
(731) 658-6011
(731) 658-9884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD9916
TN
208600000X
Surgery Physician
MD9916
TN
Other
Enumeration date
09/14/2005
Last updated
12/30/2009
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