Provider Demographics
NPI:1013228196
Name:PONUGOTI, KEERTHI KIRAN (MD)
Entity Type:Individual
Prefix:
First Name:KEERTHI
Middle Name:KIRAN
Last Name:PONUGOTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E PINETREE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4875
Mailing Address - Country:US
Mailing Address - Phone:229-584-5731
Mailing Address - Fax:229-584-5941
Practice Address - Street 1:2705 E PINETREE BLVD STE C
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4875
Practice Address - Country:US
Practice Address - Phone:229-584-5731
Practice Address - Fax:229-584-5941
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4449207R00000X
GA071394207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine