Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | MD37848 | SC |
NPI | 1023334828 |
---|---|
Provider Name | Shivakanth Burugu |
First Address | Albany, GA 31701-2057 |
Second Address | Albany, GA 31701-2057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2010 |
Last Update Date | 11/08/2017 |