Provider Demographics
NPI:1689817041
Name:MANDALAPU, KAMAL KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMAL
Middle Name:KISHORE
Last Name:MANDALAPU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:1700 HOSPITAL SOUTH DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8116
Practice Address - Country:US
Practice Address - Phone:770-944-2830
Practice Address - Fax:678-581-7170
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2019-04-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA068241207RH0003X
LA300681207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1689817041OtherNPI NUMBER