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General NPI Number Information
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NPI Number | 1407159031
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Entity Type | Organization
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Legal Business Name | J.P.GADIKOTA CORP
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Dates
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Enumeration Date | 12/21/2010
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 40 SW 12TH ST SUITE 101 B
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City | OCALA
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State | FL
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Zip | 34471-6525
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Country | US
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Telephone | 352-622-1344
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Fax |
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Provider Business Mailing Address
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Address Line | 40 SW 12TH ST SUITE 101 B
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City | OCALA
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State | FL
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Zip | 34471-6525
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Country | US
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Telephone | 352-622-1344
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JAYA PRAKASH GADIKOTA
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Credential |
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Telephone | 352-281-4323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME106624
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License Number State | FL
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