Healthcare Provider Details

I. General information

NPI: 1336540590
Provider Name (Legal Business Name): AKHILA KOTHAPALLI D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW STE 400
MARIETTA GA
30060-1147
US

IV. Provider business mailing address

7600 RIVER RD
NORTH BERGEN NJ
07047-6217
US

V. Phone/Fax

Practice location:
  • Phone: 770-528-0260
  • Fax: 770-528-0269
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number82633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: