Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 071394 | GA |
N | 111NI0900X | Internist | 071394 | GA |
N | 207R00000X | Internist | 4449 | GA |
N | 111NI0900X | Internist | 4449 | GA |
N | 207RC0200X | Critical Care Medicine | 071394 | GA |
Y | 207RP1001X | Pulmonary Disease | 071394 | GA |
NPI | 1013228196 |
---|---|
Provider Name | Keerthi Kiran Ponugoti |
First Address | Thomasville, GA 31792-4875 |
Second Address | Thomasville, GA 31792-4875 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 05/08/2020 |