Provider Demographics
NPI:1134221351
Name:KADAM, VISHWAS S (MD)
Entity type:Individual
Prefix:
First Name:VISHWAS
Middle Name:S
Last Name:KADAM
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 1:1873 EAST MAIN STREET
Mailing Address - Street 2:STE. B
Mailing Address - City:HOGANSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30230-2756
Mailing Address - Country:US
Mailing Address - Phone:706-637-9797
Mailing Address - Fax:706-637-4755
Practice Address - Street 1:1873 EAST MAIN STREET
Practice Address - Street 2:STE. B
Practice Address - City:HOGANSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30230-2756
Practice Address - Country:US
Practice Address - Phone:706-637-9797
Practice Address - Fax:706-637-4755
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO200402299207R00000X
GA62529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine