Provider Demographics
NPI:1316175573
Name:GARLA, VISHNU (MD)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:GARLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-5525
Mailing Address - Fax:601-984-5769
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DIVISION OF ENDOCRINOLOGY
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5525
Practice Address - Fax:601-984-5769
Is Sole Proprietor?:No
Enumeration Date:2009-06-26
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22669207RE0101X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07801363Medicaid
MS425909YJ5DMedicare PIN
MS07801363Medicaid