Provider Demographics
NPI:1871754036
Name:KRISHNA, GOLLAVELLI JYOTHI (MD)
Entity type:Individual
Prefix:
First Name:GOLLAVELLI
Middle Name:JYOTHI
Last Name:KRISHNA
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 1:208 OAK DR S
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5790
Mailing Address - Country:US
Mailing Address - Phone:979-230-4852
Mailing Address - Fax:979-230-4863
Practice Address - Street 1:208 OAK DR S
Practice Address - Street 2:SUITE 700
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5790
Practice Address - Country:US
Practice Address - Phone:979-230-4852
Practice Address - Fax:979-230-4863
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1937262084P0800X
TXP11902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01688384Medicaid
NY01688384Medicaid