MEDICARE: NIRMALA REDDY JETTY MD

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
1	2084P0800X	Psychiatry Physician	27667	AL

General Provider Information

NPI Number	:	1295944247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIRMALA REDDY JETTY MD

Provider Business Mailing Address
First Line	:	4268 CAHABA HEIGHTS CT STE 190
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5711
Country	:	US
Telephone Number	:	205-271-2570
Fax Number	:	205-972-8353

Provider Business Practice Location Address
First Line	:	4268 CAHABA HEIGHTS CT
Second Line	:	190
City	:	VESTAVIA
State	:	AL
Zip	:	35243-5711
Country	:	US
Telephone Number	:	205-934-5038
Fax Number	:	205-972-8353

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	02/24/2015

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