Provider Demographics
NPI:1881652519
Name:KINI, GANESH N (MD)
Entity Type:Individual
Prefix:DR
First Name:GANESH
Middle Name:N
Last Name:KINI
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 1:2601 SALEM RD SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2127
Mailing Address - Country:US
Mailing Address - Phone:770-922-1880
Mailing Address - Fax:770-388-0201
Practice Address - Street 1:2601 SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2127
Practice Address - Country:US
Practice Address - Phone:770-922-1880
Practice Address - Fax:770-388-0201
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine