=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689688970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIJAYANARAYANA RAO JAMPALA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2006
-----------------------------------------------------
Last Update Date | 04/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 WHITESPORT DR SW STE 101
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-6429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-880-4077
-----------------------------------------------------
Fax | 256-880-5277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 WHITESPORT DR SW STE 101
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-6429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-880-4077
-----------------------------------------------------
Fax | 256-880-5277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 00026049
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------