Provider Demographics
NPI:1962590075
Name:KAVURI, SREEKANTH (MD)
Entity type:Individual
Prefix:
First Name:SREEKANTH
Middle Name:
Last Name:KAVURI
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 1:105 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2501
Mailing Address - Country:US
Mailing Address - Phone:478-274-1040
Mailing Address - Fax:478-274-0075
Practice Address - Street 1:105 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2501
Practice Address - Country:US
Practice Address - Phone:478-274-1040
Practice Address - Fax:478-274-0075
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042068207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000840287AMedicaid
GA58-2484595OtherTAX ID NUMBER