Healthcare Provider Details

I. General information

NPI: 1205465952
Provider Name (Legal Business Name): VENKATKRISH MANOHAR KASETTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CAMPBELL HILL ST NW STE 300
MARIETTA GA
30060-1137
US

IV. Provider business mailing address

833 CAMPBELL HILL ST NW STE 300
MARIETTA GA
30060-1137
US

V. Phone/Fax

Practice location:
  • Phone: 770-218-1888
  • Fax:
Mailing address:
  • Phone: 770-218-1888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2024-00606
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number109488
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: