Basic Information
| Provider Information | |||||||||
| NPI: | 1295944247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JETTY | ||||||||
| FirstName: | NIRMALA | ||||||||
| MiddleName: | REDDY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4268 CAHABA HEIGHTS CT STE 190 | ||||||||
| Address2: | |||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352435711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2052712570 | ||||||||
| FaxNumber: | 2059728353 | ||||||||
| Practice Location | |||||||||
| Address1: | 4268 CAHABA HEIGHTS CT | ||||||||
| Address2: | 190 | ||||||||
| City: | VESTAVIA | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352435711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059345038 | ||||||||
| FaxNumber: | 2059728353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 27667 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.