Healthcare Provider Details

I. General information

NPI: 1194794065
Provider Name (Legal Business Name): MEENA GULATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

5100 OLD BIRMINGHAM HWY APT #1607
TUSCALOOSA AL
35404-4654
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2000
  • Fax: 205-554-2058
Mailing address:
  • Phone: 205-554-2000
  • Fax: 205-554-2058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number046857
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: