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General NPI Number Information
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NPI Number | 1699300939
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Entity Type | Organization
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Legal Business Name | CHRONIC DISEASE MANAGEMENT OF GEORGIA, LLC
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 704 BREEDLOVE DR STE A
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City | MONROE
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State | GA
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Zip | 30655-2054
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Country | US
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Telephone | 888-772-0076
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Fax | 770-751-8014
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Provider Business Mailing Address
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Address Line | PO BOX 604169
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City | CHARLOTTE
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State | NC
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Zip | 28260-4169
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Country | US
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Telephone | 888-772-0076
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Fax | 803-587-5911
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VAMSI KANAGALA
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Credential | MD
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Telephone | 803-587-5163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2081P0004X
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Taxonomy Name | Spinal Cord Injury Medicine Physician
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License Number |
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Taxonomy #3
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2081H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 2081N0008X
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Taxonomy Name | Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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