Healthcare Provider Details

I. General information

NPI: 1275945073
Provider Name (Legal Business Name): MONOJ KUMAR KONDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2014
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 01/07/2015
Reactivation Date: 01/26/2015

III. Provider practice location address

1007 GOODYEAR AVE
GADSDEN AL
35903-1195
US

IV. Provider business mailing address

PO BOX 680060
FRANKLIN TN
37068-0060
US

V. Phone/Fax

Practice location:
  • Phone: 256-494-4000
  • Fax: 659-235-6176
Mailing address:
  • Phone: 877-848-1457
  • Fax: 659-235-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52777
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301105230
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number11846
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017022830
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2017022830
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: