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General NPI Number Information
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NPI Number | 1295396539
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Entity Type | Individual
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Provider Name | GAUTAM YADLA MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2019
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 121 N 20TH ST STE 20A
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City | OPELIKA
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State | AL
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Zip | 36801-5456
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Country | US
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Telephone | 334-749-6423
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N 20TH ST STE 20A
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City | OPELIKA
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State | AL
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Zip | 36801-5456
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Country | US
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Telephone | 334-749-6423
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD.48142
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License Number State | AL
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