Healthcare Provider Details

I. General information

NPI: 1982936126
Provider Name (Legal Business Name): SUNIL MALHOTRA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 GOODMAN RD E
SOUTHAVEN MS
38671-9557
US

IV. Provider business mailing address

470 GOODMAN RD E
SOUTHAVEN MS
38671-9557
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-3330
  • Fax: 662-536-3329
Mailing address:
  • Phone: 662-536-3330
  • Fax: 662-536-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNIL MALHOTRA
Title or Position: OWNER / PHYSICIAN
Credential: M.D.
Phone: 662-536-3330