Healthcare Provider Details

I. General information

NPI: 1316190754
Provider Name (Legal Business Name): DEEPTI A GOVATHOTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 WOODMILL LN
CARTHAGE TX
75633-2865
US

IV. Provider business mailing address

PO BOX 51
CARTHAGE TX
75633-0051
US

V. Phone/Fax

Practice location:
  • Phone: 903-693-6626
  • Fax: 628-246-8409
Mailing address:
  • Phone: 903-693-6626
  • Fax: 628-246-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10031929
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: