Provider Demographics
NPI:1225325293
Name:NAGUBILLI, SUNITHA (MD)
Entity Type:Individual
Prefix:
First Name:SUNITHA
Middle Name:
Last Name:NAGUBILLI
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:322 W SOUTH ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379
Practice Address - Country:US
Practice Address - Phone:864-429-8029
Practice Address - Fax:864-429-3515
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33770207Q00000X
SC33770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC41836121OtherMEDICARE IN
SC337709Medicaid
SCSC41835019OtherMEDICARE PIN
SCSC41836067OtherMEDICARE PIN
SCSC4183H888OtherMEDICARE PIN