Provider Demographics
NPI:1790875086
Name:AMARISH KAPASI PC
Entity Type:Organization
Organization Name:AMARISH KAPASI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOI
Authorized Official - Middle Name:
Authorized Official - Last Name:FARLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-667-1077
Mailing Address - Street 1:2542 TWILIGHT VW
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7722
Mailing Address - Country:US
Mailing Address - Phone:770-667-1077
Mailing Address - Fax:770-667-9026
Practice Address - Street 1:2542 TWILIGHT VW
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-7722
Practice Address - Country:US
Practice Address - Phone:770-667-1077
Practice Address - Fax:770-667-9026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054759208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA211977445IMedicaid
GAGRP7268Medicare PIN
GA211977445IMedicaid