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Chandra Kumar Mallic Kodavanti, MD
Critical Care Medicine (Internal Medicine) Physician in Dothan, Alabama
NPI 1093236580

Chandra Kumar Mallic Kodavanti is a Critical Care Medicine (Internal Medicine) Physician based in Dothan, AL and is specialized in Critical Care Medicine. Chandra Kumar Mallic Kodavanti practices in Dothan, AL and has the professional credentials of MD. The NPI Number for Chandra Kumar Mallic Kodavanti is 1093236580 and holds a License No. RS2020-0463 (Alabama).

The current practice location address for Chandra Kumar Mallic Kodavanti is 1108 Ross Clark Cir, Dothan, AL and can be reached out via phone at 334-703-8836 and via fax at 334-712-3512.

Location: 1108 Ross Clark Cir, Dothan, AL, 36302-1928
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1093236580
Provider Name
Chandra Kumar Mallic Kodavanti
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
1108 Ross Clark Cir, Dothan, AL, 36302-1928
Phone Number
334-703-8836
Fax Number
334-712-3512
Provider Enumeration Date
07/05/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
1108 Ross Clark Cir
City
Dothan
State
Alabama
Zip
36301-3022
Phone Number
334-703-8836
Fax Number
334-712-3512
person
Provider Business Mailing Address Details
Address
1108 Ross Clark Cir
City
Dothan
State
Alabama
Zip
36301-3022
Phone Number
334-703-8836
Fax Number
334-712-3512
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Critical Care Medicine
Taxonomy
207RC0200X
License No.
BP10060414 (Texas)
Definition
An internist who diagnoses, treats and supports patients with multiple organ dysfunction. This specialist may have administrative responsibilities for intensive care units and may also facilitate and coordinate patient care among the primary physician, the critical care staff and other specialists.
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
RS2020-0463 (New Mexico)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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