Individual
SURESH THOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
143 KENNEDY DR, MARTIN, TN 38237-3309
(731) 587-5321
(731) 587-2145
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
39395
TN
207R00000X
Internal Medicine Physician
Primary
39395
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000169937
UNISON
TN
05
—
3332991
—
TN
01
—
4107565
BCBS
TN
01
—
7652703
AETNA
TN
Enumeration date
01/05/2006
Last updated
07/07/2022
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