MEDICARE: DR. PALLAVI ARCHANA KUMBLA 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
1	208200000X	Plastic Surgery Physician	90934	GA

General Provider Information

NPI Number	:	1134462534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PALLAVI ARCHANA KUMBLA MD

Provider Business Mailing Address
First Line	:	4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Second Line	:	SUITE 240
City	:	CUMMING
State	:	GA
Zip	:	30040
Country	:	US
Telephone Number	:	678-931-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Second Line	:	SUITE 240
City	:	CUMMING
State	:	GA
Zip	:	30040-3004
Country	:	US
Telephone Number	:	678-931-8874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2013
Last Update Date	:	11/27/2023

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