Provider Demographics
NPI:1053725408
Name:KUZHIPPALA, LINDA CHACKO (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:CHACKO
Last Name:KUZHIPPALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:THOMAS
Other - Last Name:CHACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 MANSELL RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1507
Mailing Address - Country:US
Mailing Address - Phone:770-521-2229
Mailing Address - Fax:770-521-2231
Practice Address - Street 1:1015 MANSELL RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:770-521-2229
Practice Address - Fax:770-521-2231
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81462207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology