Basic Information
| Provider Information | |||||||||
| NPI: | 1831260041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOKHAI | ||||||||
| FirstName: | SARVEPALLI | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6007 | ||||||||
| Address2: | |||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310956007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789290036 | ||||||||
| FaxNumber: | 4789291744 | ||||||||
| Practice Location | |||||||||
| Address1: | 1040 MORNINGSIDE DR | ||||||||
| Address2: | |||||||||
| City: | PERRY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310692904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784751299 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2006 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | POD000829 | GA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 000823941F | 05 | GA | MEDICAID |