Provider Demographics
NPI:1164592846
Name:KUMAR, VEENI S (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENI
Middle Name:S
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2307
Mailing Address - Country:US
Mailing Address - Phone:770-577-7030
Mailing Address - Fax:770-577-6844
Practice Address - Street 1:3327 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2307
Practice Address - Country:US
Practice Address - Phone:770-577-7030
Practice Address - Fax:770-577-6844
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00112032DMedicaid
NC200400698OtherSTATE LIC
GA581160821OtherTAX ID
GA00112032DMedicaid
GA581160821OtherTAX ID
NC200400698OtherSTATE LIC