Gollamudi, Subba R

Gollamudi, Subba R is an individual health care provider with primary practice located at 825 Ridge Lake Blvd , Memphis TN 38120-9411. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Gollamudi, Subba R can be contacted via phone (901) 685-2200.

Contact Information

Primary practice address
825 Ridge Lake Blvd Memphis TN 38120-9411
Phone: (901) 685-2200
Fax: (901) 820-2342
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X E-3527 Arkansas
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 16734 Mississippi
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X MD0000021892 Tennessee

Profile Details

NPI number 1154378735
LBN Legal business name Gollamudi, Subba R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 28th, 2006
Last updated Jul 25th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154378735 NPPES
Arkansas MEDICAID 121686001
Arkansas MEDICAID 3067983
Arkansas MEDICAID 00119845
Arkansas Other 180018881
Arkansas Other 180042504

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