Provider Demographics
NPI:1477531861
Name:KAVURI, VASAVI A (MD)
Entity Type:Individual
Prefix:
First Name:VASAVI
Middle Name:A
Last Name:KAVURI
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 1:227 INDUSTRIAL BLVD
Mailing Address - Street 2:P O BOX 353
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-0407
Mailing Address - Country:US
Mailing Address - Phone:478-272-1366
Mailing Address - Fax:478-275-2322
Practice Address - Street 1:104 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-1366
Practice Address - Fax:478-275-2322
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050481207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000922094DMedicaid
GA202I110859Medicare PIN
GA000922094DMedicaid
GA7534255OtherAETNA
GAH46129Medicare UPIN
GA000922094CMedicaid
GA2143332OtherUNITED HEALTHCARE