Healthcare Provider Details

I. General information

NPI: 1568956977
Provider Name (Legal Business Name): KENA PARESH VYAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 JESSE JEWELL PKWY SE
GAINESVILLE GA
30501-3756
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-539-9391
  • Fax:
Mailing address:
  • Phone: 770-848-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD18313
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLP04254
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number113759
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: