Provider Demographics
NPI:1952370959
Name:KONGARA, KAVITA RANI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAVITA
Middle Name:RANI
Last Name:KONGARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1955 LAKE PARK DR SE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8858
Mailing Address - Country:US
Mailing Address - Phone:678-223-7726
Mailing Address - Fax:678-388-1759
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1600
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2212
Practice Address - Country:US
Practice Address - Phone:404-881-1094
Practice Address - Fax:404-874-1249
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY197035207RG0100X
GA063678207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA768114952Medicaid
NY02040297Medicaid
GA202I105712OtherMEDICARE
GA768114952Medicaid