Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 89686 | GA |
Y | 111NI0900X | Internist | 89686 | GA |
NPI | 1003443615 |
---|---|
Provider Name | Sriramakrishna Rao Koganti |
First Address | Atlanta, GA 30309-1316 |
Second Address | Atlanta, GA 30309-1316 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2020 |
Last Update Date | 22/09/2021 |