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General NPI Number Information
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NPI Number | 1760609853
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Entity Type | Organization
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Legal Business Name | KRISHNA KUMAR PUDI MD PA
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110A HOSPITAL DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3226
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Country | US
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Telephone | 864-963-9090
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Fax | 864-962-0610
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Provider Business Mailing Address
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Address Line | 110A HOSPITAL DR
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3226
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Country | US
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Telephone | 864-963-9090
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Fax | 864-962-0610
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Authorized Official
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Title or Position | INSURANCE PROCESSOR
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Name | MRS. LOU JESSUP
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Credential |
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Telephone | 864-963-9090
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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 | 19077
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License Number State | SC
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