Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Chandra Kumar Mallic Kodavanti, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1093236580

Chandra Kumar Mallic Kodavanti, MD is a Critical Care (Intensivists) in Dothan, Alabama. Qualified in 2011, 15 years ago. Practices with Houston County Healthcare Authority, a 258-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Alabama, New Mexico and Texas.

Years since qualifying
15
Licensed in
AL, NM, TX
In the registry since
2017
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

1108 Ross Clark Cir
Dothan, AL 36301-3022
Phone: (334) 703-8836
Fax: (334) 712-3512
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • Msc 10-5550 1 University Of New Mexico, Albuquerque, NM 87131-0001 — (505) 272-4751
  • 701 W 5th St, Odessa, TX 79763-4206 — (432) 703-5375

Specialties & licences

Critical Care Medicine (Internal Medicine) Physician (primary) Taxonomy 207RC0200X · Licence MD.46417 (AL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence RS2020-0463 (NM)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence BP10060414 (TX)

Record details

NPI number1093236580
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 5, 2017
Last updated in NPPESJuly 25, 2023
Certification dateJuly 25, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCRITICAL CARE (INTENSIVISTS)
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Houston County Healthcare Authority — 258 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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