Provider Demographics
NPI:1164752952
Name:KONALA, VENU MADHAV (MD)
Entity Type:Individual
Prefix:DR
First Name:VENU MADHAV
Middle Name:
Last Name:KONALA
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 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:678-288-9555
Mailing Address - Fax:678-288-9556
Practice Address - Street 1:4586 TIMBER RIDGE DR STE 200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7514
Practice Address - Country:US
Practice Address - Phone:770-942-0457
Practice Address - Fax:770-942-7699
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043399390200000X
PAMT195043390200000X
KY46646207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG32296AOtherMEDICARE PTAN
GA003268156AMedicaid