Provider Demographics
NPI:1487919908
Name:KANUGULA, ASHOK KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ASHOK KUMAR
Middle Name:
Last Name:KANUGULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 S 8TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4884
Mailing Address - Country:US
Mailing Address - Phone:470-604-8250
Mailing Address - Fax:770-999-2814
Practice Address - Street 1:747 S 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4884
Practice Address - Country:US
Practice Address - Phone:470-604-8250
Practice Address - Fax:770-999-2814
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.126308207R00000X
PAMT200813390200000X
GA88543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH133401Medicaid
OH133401Medicaid