Provider Demographics
NPI:1952712788
Name:KANAGALA, VAMSI (MD)
Entity Type:Individual
Prefix:DR
First Name:VAMSI
Middle Name:
Last Name:KANAGALA
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 1:704 BREEDLOVE DR STE A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2054
Mailing Address - Country:US
Mailing Address - Phone:888-772-0076
Mailing Address - Fax:
Practice Address - Street 1:704 BREEDLOVE DR STE A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2054
Practice Address - Country:US
Practice Address - Phone:888-772-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29118207R00000X
GA13210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine