Healthcare Provider Details

I. General information

NPI: 1265745459
Provider Name (Legal Business Name): AMALESWARI PAMARTHY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 356
JACKSON MS
39216-4607
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4644
  • Fax: 601-200-4645
Mailing address:
  • Phone: 601-200-4644
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberU7134
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number22753
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD60997983
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: