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General NPI Number Information
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NPI Number | 1629066386
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Entity Type | Individual
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Provider Name | PUVALAI VIJAYKUMAR MD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2005
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 1707 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3606
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Country | US
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Telephone | 478-929-8030
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Fax | 478-929-8095
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Provider Business Mailing Address
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Address Line | 1707 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-3606
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Country | US
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Telephone | 478-929-8030
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Fax | 478-929-8095
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 18484
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35071686V
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD041441E
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 084192
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License Number State | GA
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