Healthcare Provider Details

I. General information

NPI: 1801895966
Provider Name (Legal Business Name): RAMESH BABU KANNEGENTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-9246
US

IV. Provider business mailing address

6 YOSEMITE CT
COLUMBUS GA
31907-1730
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-2889
  • Fax: 706-494-8220
Mailing address:
  • Phone: 706-653-2889
  • Fax: 706-494-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number040434
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: