Provider Demographics
NPI:1336671320
Name:PEELA, APPALA SUMAN KUMAR
Entity Type:Individual
Prefix:
First Name:APPALA
Middle Name:SUMAN KUMAR
Last Name:PEELA
Suffix:
Gender:M
Credentials:
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 920158
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0158
Mailing Address - Country:US
Mailing Address - Phone:984-974-4372
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:730 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2324
Practice Address - Country:US
Practice Address - Phone:910-738-2662
Practice Address - Fax:910-738-3730
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2020-02569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program