Provider Demographics
NPI:1033595434
Name:GATLA, SHANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTHI
Middle Name:
Last Name:GATLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 MONTLIMAR DR STE A210
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1743
Mailing Address - Country:US
Mailing Address - Phone:251-450-4359
Mailing Address - Fax:251-450-4323
Practice Address - Street 1:1015 MONTLIMAR DR
Practice Address - Street 2:A-210
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1713
Practice Address - Country:US
Practice Address - Phone:251-450-4359
Practice Address - Fax:251-450-4323
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL.4451R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry