Healthcare Provider Details

I. General information

NPI: 1134865868
Provider Name (Legal Business Name): NAGESHWAR REDDY KOTHUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SOUTH 8TH STREET
GRIFFIN GA
30224
US

IV. Provider business mailing address

1305 N ELM ST
HENDERSON KY
42420-2783
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-2721
  • Fax:
Mailing address:
  • Phone: 270-827-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number60106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: