Provider Demographics
NPI:1780725457
Name:AAA CLINICS, AMC
Entity type:Organization
Organization Name:AAA CLINICS, AMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DONEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-688-5416
Mailing Address - Street 1:8921 MANSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-2144
Mailing Address - Country:US
Mailing Address - Phone:318-688-5416
Mailing Address - Fax:318-415-0205
Practice Address - Street 1:8921 MANSFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-2144
Practice Address - Country:US
Practice Address - Phone:318-688-5416
Practice Address - Fax:318-415-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0174792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942120Medicaid
LA57931Medicare ID - Type Unspecified