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NPI Code Detail

MEDICARE: SUBBA R GOLLAMUDI M.D.

MEDICARE: SUBBA R GOLLAMUDI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology PhysicianE-3527AR
2207W00000XOphthalmology Physician16734MS
3207W00000XOphthalmology PhysicianMD0000021892TN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4180018881OTHERTNPALMETTO RR MEDICARE
5180042504OTHERMSPALMETTO RR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154378735
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUBBA R GOLLAMUDI M.D.
Provider Business Mailing Address
First Line : PO BOX 22510
Second Line :
City : JACKSON
State : MS
Zip : 39225-2510
Country : US
Telephone Number : 901-685-2200
Fax Number : 901-255-5631
Provider Business Practice Location Address
First Line : 825 RIDGE LAKE BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-9411
Country : US
Telephone Number : 901-685-2200
Fax Number : 901-820-2342
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/28/2006
Last Update Date : 07/25/2022

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Directions to “ SUBBA R GOLLAMUDI M.D.” Practice Location

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