Provider Demographics
NPI:1831260041
Name:JOKHAI, SARVEPALLI
Entity type:Individual
Prefix:
First Name:SARVEPALLI
Middle Name:
Last Name:JOKHAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6007
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31095-6007
Mailing Address - Country:US
Mailing Address - Phone:478-929-0036
Mailing Address - Fax:478-929-1744
Practice Address - Street 1:1040 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2904
Practice Address - Country:US
Practice Address - Phone:478-475-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000829213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000823941FMedicaid
GA000823941FMedicaid