Provider Demographics
NPI:1316190754
Name:GOVATHOTI, DEEPTI A (MD)
Entity Type:Individual
Prefix:
First Name:DEEPTI
Middle Name:A
Last Name:GOVATHOTI
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 51
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75633-0051
Mailing Address - Country:US
Mailing Address - Phone:903-693-6626
Mailing Address - Fax:628-246-8409
Practice Address - Street 1:121 WOODMILL LN
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2865
Practice Address - Country:US
Practice Address - Phone:903-693-6626
Practice Address - Fax:628-246-8409
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10031929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine