Provider Demographics
NPI:1609067081
Name:VENKATESH, KOTA (MD)
Entity Type:Individual
Prefix:
First Name:KOTA
Middle Name:
Last Name:VENKATESH
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 1:3905 JOHNS CREEK CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1224
Mailing Address - Country:US
Mailing Address - Phone:770-495-0799
Mailing Address - Fax:770-495-0783
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:SUITE 200
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1224
Practice Address - Country:US
Practice Address - Phone:770-495-0799
Practice Address - Fax:770-495-0783
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062621208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery