Provider Demographics
NPI:1417970518
Name:PIDIKITI, NANNI (MD)
Entity Type:Individual
Prefix:
First Name:NANNI
Middle Name:
Last Name:PIDIKITI
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 1:703 ALCORN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9302
Mailing Address - Country:US
Mailing Address - Phone:662-286-9393
Mailing Address - Fax:662-286-9533
Practice Address - Street 1:703 ALCORN DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9302
Practice Address - Country:US
Practice Address - Phone:662-286-9393
Practice Address - Fax:662-286-9533
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13497207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00113432Medicaid
MS00113432Medicaid