Provider Demographics
NPI:1790849495
Name:VEMURI, KAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:VEMURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5670
Mailing Address - Fax:615-377-1678
Practice Address - Street 1:6501 PEAKE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8042
Practice Address - Country:US
Practice Address - Phone:478-476-9285
Practice Address - Fax:478-474-9034
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA055350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA622559586AMedicaid
GAP00147062Medicare PIN
GAI17511Medicare UPIN
GA11SCDHFMedicare PIN