Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD39296 | SC |
Y | 111NI0900X | Internist | MD39296 | SC |
NPI | 1003258237 |
---|---|
Provider Name | Dr. Satya Datla |
First Address | Royal Oak, MI 48067-3515 |
Second Address | Florence, SC 29506-2617 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2013 |
Last Update Date | 27/06/2016 |