Provider Demographics
NPI:1922456300
Name:K.V. PANCHAPAKASAN, M.D. PC
Entity Type:Organization
Organization Name:K.V. PANCHAPAKASAN, M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KALAMBUR
Authorized Official - Middle Name:V
Authorized Official - Last Name:PANCHAPAKESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-633-7010
Mailing Address - Street 1:818 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2139
Mailing Address - Country:US
Mailing Address - Phone:478-633-7010
Mailing Address - Fax:478-633-7585
Practice Address - Street 1:818 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2139
Practice Address - Country:US
Practice Address - Phone:478-633-7010
Practice Address - Fax:478-633-7585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42912207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty