Provider Demographics
NPI:1821419961
Name:GOVATHOTI MD SERVICES PLLC
Entity Type:Organization
Organization Name:GOVATHOTI MD SERVICES PLLC
Other - Org Name:DEEPTI GOVATHOTI MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEEPTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOVATHOTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-693-6626
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 1:116 WOODMILL LN
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:TX
Practice Address - Zip Code:75633-2861
Practice Address - Country:US
Practice Address - Phone:903-331-0506
Practice Address - Fax:903-331-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP03937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty