Healthcare Provider Details

I. General information

NPI: 1669409629
Provider Name (Legal Business Name): RAMANA KUMAR PUPPALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

IV. Provider business mailing address

300 N COLLEGE ST
GREENVILLE AL
36037-2025
US

V. Phone/Fax

Practice location:
  • Phone: 334-382-1015
  • Fax: 334-382-1039
Mailing address:
  • Phone: 334-382-1015
  • Fax: 334-382-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number036110928
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number70896
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number29509
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: