Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 13482 | GA |
NPI | 1063084580 |
---|---|
Provider Name | Jahnavi Kandepu |
First Address | North Augusta, SC 29841-4378 |
Second Address | Augusta, GA 30912-0002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |