Healthcare Provider Details

I. General information

NPI: 1902340953
Provider Name (Legal Business Name): NAVYA KUCHIPUDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2016
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MEDICAL PARK RD STE 501
COLUMBIA SC
29203-6839
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-3320
  • Fax: 803-540-1011
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-293-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25MA10566200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number86439
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: