Provider Demographics
NPI:1093742744
Name:KINI, GANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:
Last Name:KINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GANESH
Other - Middle Name:
Other - Last Name:KINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-854-6946
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-5795
Practice Address - Fax:706-774-5792
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501387207R00000X
GA87205207R00000X
VA0101239762208M00000X
ORMD180177207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05754OtherRMH MEDICARE GROUP PTAN
VA1417027608OtherRMH GROUP NPI