Provider Demographics
NPI:1225072044
Name:SUNEELA, GOTTUMUKKALA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GOTTUMUKKALA
Middle Name:
Last Name:SUNEELA
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 1:2996 KATE BOND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4030
Mailing Address - Country:US
Mailing Address - Phone:901-382-2044
Mailing Address - Fax:901-382-2085
Practice Address - Street 1:2996 KATE BOND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4030
Practice Address - Country:US
Practice Address - Phone:901-382-2044
Practice Address - Fax:901-382-2085
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4152593OtherBLUE CROSS
TNI25647Medicare UPIN
TN3327582Medicare ID - Type Unspecified