Healthcare Provider Details

I. General information

NPI: 1356532196
Provider Name (Legal Business Name): VIKAS KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST DEPARTMENT OF ANESTHESIOLOGY
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST DEPARTMENT OF ANESTHESIOLOGY
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3871
  • Fax:
Mailing address:
  • Phone: 706-721-3871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68049
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number068049
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: