| Jetty Psychiatric Services Llc | |
|
401 Tuscaloosa Ave Sw Suite 110 Birmingham AL 35211-1416 | |
| (205) 785-2000 | |
| (205) 785-2945 |
| Full Name | Jetty Psychiatric Services Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 401 Tuscaloosa Ave Sw, Birmingham, Alabama |
| Authorized Official Name and Position | Praveen Jetty (OWNER/M.D.) |
| Authorized Official Contact | 2057852000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jetty Psychiatric Services Llc Po Box 382664 Birmingham AL 35238-2664 Ph: (205) 785-2000 | Jetty Psychiatric Services Llc 401 Tuscaloosa Ave Sw Suite 110 Birmingham AL 35211-1416 Ph: (205) 785-2000 |
| NPI Number | 1750576815 |
|---|---|
| Provider Enumeration Date | 09/12/2007 |
| Last Update Date | 09/12/2007 |
| Medicare PECOS PAC ID | 4789766924 |
|---|---|
| Medicare Enrollment ID | O20080128000408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750576815 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Praveen Jetty |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174613160 PECOS PAC ID: 9032002316 Enrollment ID: I20040203000185 |
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