Healthcare Provider Details

I. General information

NPI: 1568639466
Provider Name (Legal Business Name): SANTHOSH KUMAR BANGALORE VASANTHA KUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANTHOSH KUMAR MD

II. Dates (important events)

Enumeration Date: 05/11/2008
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

IV. Provider business mailing address

1605 CHANTILLY DR NE
ATLANTA GA
30324-3267
US

V. Phone/Fax

Practice location:
  • Phone: 804-517-2232
  • Fax: 404-778-4431
Mailing address:
  • Phone: 804-517-2232
  • Fax: 404-778-4431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number0101247688
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number103011
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: