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NPI Code Detail

MEDICARE: MRS. GOTTUMUKKALA SUNEELA M.D.

MEDICARE: MRS. GOTTUMUKKALA SUNEELA 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
1207Q00000XFamily Medicine PhysicianMD0000039069TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14152593OTHERTNBLUE CROSS

General Provider Information

NPI Number : 1225072044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GOTTUMUKKALA SUNEELA M.D.
Provider Business Mailing Address
First Line : 2996 KATE BOND RD
Second Line : SUITE 203
City : BARTLETT
State : TN
Zip : 38133-4030
Country : US
Telephone Number : 901-382-2044
Fax Number : 901-382-2085
Provider Business Practice Location Address
First Line : 2996 KATE BOND RD
Second Line : SUITE 203
City : BARTLETT
State : TN
Zip : 38133-4030
Country : US
Telephone Number : 901-382-2044
Fax Number : 901-382-2085
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2006
Last Update Date : 07/24/2007

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