Provider Demographics
NPI:1669464681
Name:KAMEPALLI, RAVI KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:KUMAR
Last Name:KAMEPALLI
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 1:505 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:706-739-7789
Mailing Address - Fax:706-739-7776
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:706-739-7776
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85111207RI0200X
OH35082248207RI0200X
IN01081157A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2402046Medicaid
GAG18732AOtherMEDICARE
GA003232464AMedicaid
IN300021480Medicaid