Healthcare Provider Details

I. General information

NPI: 1700865987
Provider Name (Legal Business Name): SINDHU H THOTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 OCEAN BLVD
SAINT SIMONS ISLAND GA
31522-4826
US

IV. Provider business mailing address

540 OCEAN BLVD
SAINT SIMONS ISLAND GA
31522-4826
US

V. Phone/Fax

Practice location:
  • Phone: 912-638-8073
  • Fax: 912-638-6628
Mailing address:
  • Phone: 912-638-8073
  • Fax: 912-638-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number017651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: