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General NPI Number Information
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NPI Number | 1124751235
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Entity Type | Individual
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Provider Name | VENKATA GANDI MD
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Gender | Male
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 2501 N PATTERSON ST
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City | VALDOSTA
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State | GA
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Zip | 31602-1735
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Country | US
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Telephone | 229-333-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 23257 SOUTHDOWN MANOR TER UNIT 106
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City | ASHBURN
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State | VA
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Zip | 20148-8176
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13980
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License Number State | GA
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