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General NPI Number Information
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NPI Number | 1780725457
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Entity Type | Organization
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Legal Business Name | AAA CLINICS, AMC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8921 MANSFIELD RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-2144
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Country | US
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Telephone | 318-688-5416
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Fax | 318-415-0205
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Provider Business Mailing Address
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Address Line | 8921 MANSFIELD RD
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City | SHREVEPORT
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State | LA
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Zip | 71118-2144
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Country | US
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Telephone | 318-688-5416
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Fax | 318-415-0205
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SURESH KUMAR DONEPUDI
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Credential | M.D.
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Telephone | 318-688-5416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 017479
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License Number State | LA
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