Healthcare Provider Details

I. General information

NPI: 1942813506
Provider Name (Legal Business Name): UMA MAHESH REDDY AVULA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 RIVERVIEW DR STE A
FLOWOOD MS
39232-8908
US

IV. Provider business mailing address

102 RIVERVIEW DR STE A
FLOWOOD MS
39232-8908
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberT-4200
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: