Yn Pakkala M.D, P.C

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD9916 Issued in TN

Legal business name

YN PAKKALA M.D, P.C

Practice address

630 Nuckolls Rd
Bolivar, TN 38008-1532

Phone

(731) 658-6011

Fax

(731) 658-9884

NPI assigned

Jul 12, 2012

Last updated

Sep 9, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nithyananda Pakkala, MDNPI 1578558607

Title

Doctor

Phone

(731) 658-6011

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nithyananda Pakkala, M.D.

  • Family Medicine Physician
  • Bolivar, TN
  • NPI 1578558607
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378684800000",
    "number": "1841555141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-6011",
            "fax_number": "731-658-9884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 NUCKOLLS RD",
            "city": "BOLIVAR",
            "state": "TN",
            "postal_code": "380081532",
            "telephone_number": "731-658-6011",
            "fax_number": "731-658-9884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YN PAKKALA M.D, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-12",
        "last_updated": "2013-09-09",
        "status": "A",
        "authorized_official_last_name": "PAKKALA",
        "authorized_official_first_name": "NITHYANANDA",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "731-658-6011",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "MD9916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanya S Willis
• Joselyn Wilson, PSYCHOLOGY
• Mary Wilson
• Thomas Gregory Wilson, DDS
• Sherwin A Yaffe, M.D.
• Amanda Megan Young Nibber, LPCC
• Janet M Young, R.N.
• Mary Young, RN,BSN

• General Practice Physician in Bolivar, TN
• Providers in Bolivar, TN by specialty
• General Practice Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.