Healthcare Provider Details

I. General information

NPI: 1386170892
Provider Name (Legal Business Name): SRINITHYA MALLELA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2017
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY # U56
KNOXVILLE TN
37920-1511
US

IV. Provider business mailing address

PO BOX 415000-MSC8135
NASHVILLE TN
37241-8135
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9081
  • Fax: 865-305-8769
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number64339
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number64339
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: