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General NPI Number Information
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NPI Number | 1548455900
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Entity Type | Individual
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Provider Name | VENU KARTHIK THIRUKONDA M.D
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Gender | Male
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 1514 VERNON RD
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City | LAGRANGE
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State | GA
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Zip | 30240
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Country | US
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Telephone | 706-812-2426
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Fax | 706-845-2427
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Provider Business Mailing Address
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Address Line | 1514 VERNON RD
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City | LAGRANGE
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State | GA
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Zip | 30240-4131
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Country | US
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Telephone | 706-812-2426
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Fax | 706-845-2427
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 26128
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 83398
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License Number State | GA
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