Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 82954 | GA |
NPI | 1104267525 |
---|---|
Provider Name | Manohar Kuruva |
First Address | Atlanta, GA 30322-1059 |
Second Address | Atlanta, GA 30322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2013 |
Last Update Date | 11/09/2019 |