Provider Demographics
NPI:1124003587
Name:KUMAR, PREM (MD)
Entity Type:Individual
Prefix:DR
First Name:PREM
Middle Name:
Last Name:KUMAR
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 1:3300 GREYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1096
Mailing Address - Country:US
Mailing Address - Phone:229-247-7700
Mailing Address - Fax:229-247-2666
Practice Address - Street 1:3300 GREYSTONE WAY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1096
Practice Address - Country:US
Practice Address - Phone:229-247-7700
Practice Address - Fax:229-247-2666
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA466691207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00814107IMedicaid
GA00814107JMedicaid
GA00814107JMedicaid