Provider Demographics
NPI:1851315576
Name:RAMESH, KALLAMBELLA (MD)
Entity Type:Individual
Prefix:
First Name:KALLAMBELLA
Middle Name:
Last Name:RAMESH
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 1:225 S MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-1629
Mailing Address - Country:US
Mailing Address - Phone:770-267-2541
Mailing Address - Fax:770-267-3278
Practice Address - Street 1:225 S MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-1629
Practice Address - Country:US
Practice Address - Phone:770-267-2541
Practice Address - Fax:770-267-3278
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21575207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE51531Medicare UPIN