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General NPI Number Information
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NPI Number | 1841555141
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Entity Type | Organization
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Legal Business Name | YN PAKKALA M.D, P.C
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Dates
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Enumeration Date | 07/12/2012
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Last Update Date | 09/09/2013
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Provider Practice Location Address
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Address Line | 630 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1532
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Country | US
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Telephone | 731-658-6011
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Fax | 731-658-9884
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Provider Business Mailing Address
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Address Line | 630 NUCKOLLS RD
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City | BOLIVAR
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State | TN
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Zip | 38008-1532
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Country | US
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Telephone | 731-658-6011
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Fax | 731-658-9884
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. NITHYANANDA PAKKALA
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Credential | MD
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Telephone | 731-658-6011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | MD9916
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License Number State | TN
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