Healthcare Provider Details

I. General information

NPI: 1598321598
Provider Name (Legal Business Name): DEEPTI KANTAMANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date: 07/26/2019
Reactivation Date: 07/31/2019

III. Provider practice location address

1831 5TH AVE
COLUMBUS GA
31904-8915
US

IV. Provider business mailing address

1831 5TH AVE
COLUMBUS GA
31904-8915
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-8780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number103542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: