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General NPI Number Information
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NPI Number | 1033524897
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Entity Type | Individual
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Provider Name | SRAVANI BANTU M.D
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Gender | Female
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 1400 HIGHWAY DR
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City | OXFORD
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State | AL
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Zip | 36203-1951
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Country | US
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Telephone | 256-231-7500
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Fax | 256-231-7501
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Provider Business Mailing Address
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Address Line | PO BOX 2345
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City | ANNISTON
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State | AL
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Zip | 36202-2345
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Country | US
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Telephone | 256-235-5639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36261
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 6253
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License Number State | WV
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