MEDICARE: DR. KAVITA RANI KONGARA 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	207RG0100X	Gastroenterology Physician	197035	NY
2	207RG0100X	Gastroenterology Physician	063678	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	202I105712	OTHER	GA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952370959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAVITA RANI KONGARA M.D.

Provider Business Mailing Address
First Line	:	1955 LAKE PARK DR SE
Second Line	:	SUITE 250
City	:	SMYRNA
State	:	GA
Zip	:	30080-8858
Country	:	US
Telephone Number	:	678-223-7726
Fax Number	:	678-388-1759

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	SUITE 1600
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-881-1094
Fax Number	:	404-874-1249

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/17/2017

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Directions to “ DR. KAVITA RANI KONGARA M.D.” Practice Location

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