Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 27846 | GA |
Y | 207RG0300X | Geriatric Medicine | 027846 | GA |
NPI | 1891788741 |
---|---|
Provider Name | Dr. Chadalavada N Kishore |
First Address | Columbus, GA 31908-4009 |
Second Address | Albany, GA 31701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2005 |
Last Update Date | 01/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000312881C | (05) | GA |
00312881A | (05) | GA |
A83425 | (02) | |
A83425 | (02) | GA |