Healthcare Provider Details

I. General information

NPI: 1356432264
Provider Name (Legal Business Name): SWAROOP MITTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33700 HWY 43 SUITE B
THOMASVILLE AL
36784-3555
US

IV. Provider business mailing address

403 PEBBLE CREEK LN
ENTERPRISE AL
36330-8307
US

V. Phone/Fax

Practice location:
  • Phone: 334-636-4431
  • Fax: 334-636-6129
Mailing address:
  • Phone: 985-626-6133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number00022410
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: