Healthcare Provider Details

I. General information

NPI: 1710983341
Provider Name (Legal Business Name): SAI KISHORE NANDAMURU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SCHATULGA RD
COLUMBUS GA
31907-3117
US

IV. Provider business mailing address

105 WAILEA CT
COLUMBUS GA
31909-8059
US

V. Phone/Fax

Practice location:
  • Phone: 706-568-6988
  • Fax:
Mailing address:
  • Phone: 706-568-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number041910
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: