Provider Demographics
NPI:1316268626
Name:JOTHY, ANITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:JOTHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5003 S MIAMI BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-8589
Mailing Address - Country:US
Mailing Address - Phone:919-354-0840
Mailing Address - Fax:877-840-6694
Practice Address - Street 1:6060 PIEDMONT ROW DR S STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28287-3803
Practice Address - Country:US
Practice Address - Phone:980-326-3277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2020-011222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program