Healthcare Provider Details

I. General information

NPI: 1114772035
Provider Name (Legal Business Name): SRI DHEERAJA KOTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 01/30/2025
Certification Date:
Deactivation Date: 12/23/2024
Reactivation Date: 01/30/2025

III. Provider practice location address

5 MOBILE INFIRMARY CIRCLE
MOBILE AL
36607
US

IV. Provider business mailing address

5 MOBILE INFIRMARY CIRCLE
MOBILE AL
36607
US

V. Phone/Fax

Practice location:
  • Phone: 251-435-7151
  • Fax:
Mailing address:
  • Phone: 251-435-7151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: