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General NPI Number Information
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NPI Number | 1871361121
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Entity Type | Organization
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Legal Business Name | SAI SANJEEVANI MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/15/2023
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 785 OHIO AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-6217
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Country | US
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Telephone | 662-351-0702
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Fax |
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Provider Business Mailing Address
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Address Line | 785 OHIO AVE
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City | CLARKSDALE
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State | MS
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Zip | 38614-6217
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GOWDHAMI MOHAN
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Credential | MD
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Telephone | 662-351-0702
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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 |
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License Number State |
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