Healthcare Provider Details

I. General information

NPI: 1902175649
Provider Name (Legal Business Name): GAJAPATHIRAJU CHAMARTHI M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 S UNIVERSITY BLVD STE A
MOBILE AL
36608-3078
US

IV. Provider business mailing address

PO BOX 100224
GAINESVILLE FL
32610-0224
US

V. Phone/Fax

Practice location:
  • Phone: 513-435-0042
  • Fax: 251-343-8383
Mailing address:
  • Phone: 352-273-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number45944
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME139158
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: