Provider Demographics
NPI:1033100797
Name:KAKARALA, MEENAKSHI HEMA (MD)
Entity Type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:HEMA
Last Name:KAKARALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEENA
Other - Middle Name:HEMA
Other - Last Name:KAKARALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:790 CHURCH ST NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7282
Mailing Address - Country:US
Mailing Address - Phone:678-797-8201
Mailing Address - Fax:
Practice Address - Street 1:790 CHURCH ST NE
Practice Address - Street 2:SUITE 250
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7282
Practice Address - Country:US
Practice Address - Phone:678-797-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80724207R00000X
GA61974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260861800Medicaid
2508903OtherAETNA HMO
3764898001OtherCIGNA
FL260861800Medicaid
3764898001OtherCIGNA