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General NPI Number Information
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NPI Number | 1487919908
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Entity Type | Individual
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Provider Name | ASHOK KUMAR KANUGULA M.D
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Gender | Male
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Dates
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Enumeration Date | 07/10/2012
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 747 S 8TH ST STE B
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City | GRIFFIN
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State | GA
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Zip | 30224-4884
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Country | US
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Telephone | 470-604-8250
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Fax | 770-999-2814
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Provider Business Mailing Address
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Address Line | 747 S 8TH ST STE B
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City | GRIFFIN
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State | GA
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Zip | 30224-4884
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Country | US
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Telephone | 470-604-8250
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Fax | 770-999-2814
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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 | 35.126308
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License Number State | OH
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Taxonomy #2
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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 | MT200813
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 88543
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License Number State | GA
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