Provider Demographics
NPI:1649209214
Name:REGIONAL INFECTIOUS DISEASES AND INFUSION CENTER INC
Entity Type:Organization
Organization Name:REGIONAL INFECTIOUS DISEASES AND INFUSION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:567-204-0745
Mailing Address - Street 1:505 JENKINS ST
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4225
Mailing Address - Country:US
Mailing Address - Phone:567-204-0745
Mailing Address - Fax:706-739-7789
Practice Address - Street 1:505 JENKINS ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4225
Practice Address - Country:US
Practice Address - Phone:706-739-7789
Practice Address - Fax:706-739-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066788207RI0200X
207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003232464IMedicaid
GAG187324214OtherMEDICARE