Healthcare Provider Details

I. General information

NPI: 1215719968
Provider Name (Legal Business Name): DR. HARIKA KARUNAKOTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 INTERSTATE PKWY
AUGUSTA GA
30909-5625
US

IV. Provider business mailing address

23050 BROOKSBANK SQ
BRAMBLETON VA
20148-4943
US

V. Phone/Fax

Practice location:
  • Phone: 706-651-2020
  • Fax:
Mailing address:
  • Phone: 856-630-9406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2441
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: