Provider Demographics
NPI:1134462534
Name:KUMBLA, PALLAVI ARCHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:ARCHANA
Last Name:KUMBLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:678-931-8874
Mailing Address - Fax:
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-3004
Practice Address - Country:US
Practice Address - Phone:678-931-8874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA90934208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery