Provider Demographics
NPI:1922057645
Name:AVOTRI, KOSI JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:KOSI
Middle Name:JAMES
Last Name:AVOTRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 PADGETT SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-4011
Mailing Address - Country:US
Mailing Address - Phone:251-824-2174
Mailing Address - Fax:
Practice Address - Street 1:12701 PADGETT SWITCH RD
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:AL
Practice Address - Zip Code:36544-4011
Practice Address - Country:US
Practice Address - Phone:251-824-2174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22397208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL200280Medicaid
AL167989Medicaid
AL630403074Medicaid
AL630405074Medicaid
AL630408074Medicaid
AL630412074Medicaid
AL630406074Medicaid
LA1794414Medicaid
AL630404074Medicaid
AL630411074Medicaid
AL630401074Medicaid
AL630408074Medicaid
AL630403074Medicaid
AL630401074Medicaid