MEDICARE: HARITHA V GUTTIKONDA 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
1	207Q00000X	Family Medicine Physician	MD.29010	AL

General Provider Information

NPI Number	:	1912162504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARITHA V GUTTIKONDA M.D.

Provider Business Mailing Address
First Line	:	2147 RIVERCHASE OFFICE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-1836
Country	:	US
Telephone Number	:	205-403-8902
Fax Number	:	205-982-0278

Provider Business Practice Location Address
First Line	:	2147 RIVERCHASE OFFICE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35244-1836
Country	:	US
Telephone Number	:	205-403-8902
Fax Number	:	205-982-0278

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

Provider Enumeration Date	:	07/23/2008
Last Update Date	:	09/20/2012

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