Gajula, Viswanath

Gajula, Viswanath is an individual health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine is his primary health care specialty. Gajula, Viswanath can be contacted via phone (601) 815-8173.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-8173
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301094415 Michigan
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X 4301094415 Michigan
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 23809 Mississippi

Profile Details

NPI number 1710113998
LBN Legal business name Gajula, Viswanath
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2009
Last updated Sep 10th, 2015 - about 11 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 1710113998 NPPES
Mississippi MEDICAID 05158239

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