Provider Demographics
NPI:1942732862
Name:JAMISETTI, SADHIKA MUDUNURI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SADHIKA
Middle Name:MUDUNURI
Last Name:JAMISETTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SADHIKA
Other - Middle Name:
Other - Last Name:MUDUNURI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:UNIVERSITY OF ALABAMA, DEPARTMENT OF FAMILY MEDICINE
Mailing Address - Street 2:850 PETER BRYCE BLVD
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401
Mailing Address - Country:US
Mailing Address - Phone:205-348-1211
Mailing Address - Fax:205-348-6561
Practice Address - Street 1:2731 ML KING JR BLVD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-5235
Practice Address - Country:US
Practice Address - Phone:205-349-3250
Practice Address - Fax:205-752-1517
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALMD.41100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program