Individual
MR. JAGAN ANNABATHULA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7629 KY ROUTE 979, GRETHEL, KY 41631-6304
(606) 587-2200
(606) 587-2203
Mailing address
1709 KY ROUTE 321, STE 3, PRESTONSBURG, KY 41653-9101
(606) 886-8546
(606) 886-8548
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33239
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64018427
—
KY
Enumeration date
08/16/2005
Last updated
07/08/2007
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