Healthcare Provider Details

I. General information

NPI: 1942266408
Provider Name (Legal Business Name): SRIDHAR KRISHNAMURTI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MARIARDEN RD LAKE MARTIN COMMUNITY HOSPITAL
DADEVILLE AL
36853
US

IV. Provider business mailing address

2257 BARRINGTON CT
AUBURN AL
36830-4243
US

V. Phone/Fax

Practice location:
  • Phone: 256-825-7821
  • Fax: 256-825-5742
Mailing address:
  • Phone: 334-844-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number788A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: