Healthcare Provider Details

I. General information

NPI: 1548259559
Provider Name (Legal Business Name): RADHA INAGANDLA ALUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-2005
  • Fax: 601-984-6439
Mailing address:
  • Phone: 601-825-7280
  • Fax: 601-825-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number24176
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036-110001
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: