Provider Demographics
NPI:1598015133
Name:NAGULA & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NAGULA & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIWAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:912-673-7074
Mailing Address - Street 1:1361 13TH AVE S
Mailing Address - Street 2:SUITE 140
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-3233
Mailing Address - Country:US
Mailing Address - Phone:904-261-8400
Mailing Address - Fax:904-261-2255
Practice Address - Street 1:1361 13TH AVE S
Practice Address - Street 2:SUITE 140
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-3233
Practice Address - Country:US
Practice Address - Phone:904-261-8400
Practice Address - Fax:904-261-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty