MEDICARE: RAMYA SAI DURGA KANAGALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1134057615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMYA SAI DURGA KANAGALA

Provider Business Mailing Address
First Line	:	11 UPPER RIVERDALE ROAD, SW
Second Line	:
City	:	RIVERDALE
State	:	GA
Zip	:	30274
Country	:	US
Telephone Number	:	770-991-8087
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 UPPER RIVERDALE ROAD
Second Line	:	SUITE 210
City	:	RIVERDALE
State	:	GA
Zip	:	30274
Country	:	US
Telephone Number	:	770-991-8570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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