Provider Demographics
NPI:1629166335
Name:PURI, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:KUMAR
Last Name:PURI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1209 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2395
Mailing Address - Country:US
Mailing Address - Phone:478-452-3200
Mailing Address - Fax:478-452-1515
Practice Address - Street 1:1120 15TH STREET
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-8623
Practice Address - Fax:706-721-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2024-02-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA60232207RS0012X, 207RP1001X, 207R00000X, 207RC0200X
FLTRN9114207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRES000Medicare UPIN