Provider Demographics
NPI:1437331196
Name:KUNJUMMEN, BINU JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:BINU
Middle Name:JAMES
Last Name:KUNJUMMEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1468 MONTREAL RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6901
Mailing Address - Country:US
Mailing Address - Phone:770-638-1400
Mailing Address - Fax:770-638-1411
Practice Address - Street 1:1468 MONTREAL RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6901
Practice Address - Country:US
Practice Address - Phone:770-638-1400
Practice Address - Fax:770-638-1411
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065135207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100222GMedicaid
GA202I60665Medicare PIN