Individual
KETANKUMAR BODARYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2117 BROADWAY DRIVE, HATTIESBURG, MS 39402-3210
(601) 288-8050
(601) 288-8058
Mailing address
2117 BROADWAY DRIVE, HATTIESBURG, MS 39402-3210
(601) 288-8050
(601) 288-8058
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
2021-00515
NC
2084P0804X
Child & Adolescent Psychiatry Physician
2021-00515
NC
2084P0804X
Child & Adolescent Psychiatry Physician
D0081182
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
OH
Other
Enumeration date
02/23/2011
Last updated
06/13/2025
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