MEDICARE: NANDHAKUMAR KANAGARAJAN M.D.

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	207R00000X	Internal Medicine Physician	MD429444	PA
2	207RG0100X	Gastroenterology Physician	247627	MA
3	207RG0100X	Gastroenterology Physician	68180	GA

General Provider Information

NPI Number	:	1902819667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANDHAKUMAR KANAGARAJAN M.D.

Provider Business Mailing Address
First Line	:	2020 CUMMING HWY STE 102
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8071
Country	:	US
Telephone Number	:	678-593-1295
Fax Number	:	678-593-1294

Provider Business Practice Location Address
First Line	:	2020 CUMMING HWY STE 102
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-8071
Country	:	US
Telephone Number	:	678-593-1295
Fax Number	:	678-593-1294

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	08/15/2024

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