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General NPI Number Information
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NPI Number | 1104267525
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Entity Type | Individual
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Provider Name | MANOHAR KURUVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2013
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322
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Country | US
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Telephone | 404-778-4747
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Fax | 404-686-5709
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Provider Business Mailing Address
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Address Line | 1364 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30322-1059
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Country | US
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Telephone | 404-778-4747
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Fax | 404-686-5709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207U00000X
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Taxonomy Name | Nuclear Medicine Physician
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License Number | 82954
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 82954
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME149129
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License Number State | FL
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