Individual
SHRUTHI PONNALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
329 NC HIGHWAY 801 N, BERMUDA RUN, NC 27006-7905
(336) 998-2228
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 998-2228
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
74497
MN
208M00000X
Hospitalist Physician
Primary
2024-03218
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2020
Last updated
04/16/2025
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