Healthcare Provider Details

I. General information

NPI: 1386374908
Provider Name (Legal Business Name): AKHIL GOLLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

IV. Provider business mailing address

315 GREENFIELD RD
BRIDGEWATER NJ
08807-3715
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8561
  • Fax: 941-308-8691
Mailing address:
  • Phone: 908-327-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT226553
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME183973
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: