MEDICARE: CHRONIC DISEASE MANAGEMENT OF GEORGIA, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
2	2081P0004X	Spinal Cord Injury Medicine Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
4	363LG0600X	Gerontology Nurse Practitioner
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
6	207N00000X	Dermatology Physician
7	207RN0300X	Nephrology Physician
8	2081H0002X	Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician
9	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
10	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
11	207RI0200X	Infectious Disease Physician
12	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1699300939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRONIC DISEASE MANAGEMENT OF GEORGIA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 604169
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4169
Country	:	US
Telephone Number	:	888-772-0076
Fax Number	:	803-587-5911

Provider Business Practice Location Address
First Line	:	704 BREEDLOVE DR STE A
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-2054
Country	:	US
Telephone Number	:	888-772-0076
Fax Number	:	770-751-8014

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. VAMSI KANAGALA
Credential	:	MD
Telephone Number	:	803-587-5163

Provider Enumeration Date	:	03/06/2020
Last Update Date	:	12/02/2025

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