Provider Demographics
NPI:1407029515
Name:RAMESH B KANNEGENTI MD PC
Entity Type:Organization
Organization Name:RAMESH B KANNEGENTI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:BABU
Authorized Official - Last Name:KANNEGENTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-653-2889
Mailing Address - Street 1:820 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-9246
Mailing Address - Country:US
Mailing Address - Phone:706-653-2889
Mailing Address - Fax:706-494-8220
Practice Address - Street 1:820 BROOKSTONE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-9246
Practice Address - Country:US
Practice Address - Phone:706-653-2889
Practice Address - Fax:706-494-8220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0404342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000876279BMedicaid
GA581371OtherVALUE OPTIONS
GA104482OtherCENPATICO
GAG65360Medicare UPIN
GA104482OtherCENPATICO