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Individual

DR. VISWANATH GAJULA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8173
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-8173

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301094415
MI
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
23809
MS
390200000X
Student in an Organized Health Care Education/Training Program
4301094415
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05158239
MS
Enumeration date
06/02/2009
Last updated
09/10/2015
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