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NPI Code Detail

MEDICARE: KESAVAN GOPA KUMAR MD

MEDICARE: KESAVAN GOPA KUMAR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician020562GA

General Provider Information

NPI Number : 1124016860
Entity Type Code : Individual
Provider Name (Legal Business Name) : KESAVAN GOPA KUMAR MD
Provider Business Mailing Address
First Line : 3207 COUNTRY CLUB DR
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-1029
Country : US
Telephone Number : 229-242-8480
Fax Number :
Provider Business Practice Location Address
First Line : 3207 COUNTRY CLUB DR
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-1029
Country : US
Telephone Number : 229-242-8480
Fax Number : 229-241-0252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 09/18/2008

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Directions to “ KESAVAN GOPA KUMAR MD” Practice Location

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