Provider Demographics
NPI:1528055027
Name:KAMATH, ANANTHA N (MD)
Entity type:Individual
Prefix:DR
First Name:ANANTHA
Middle Name:N
Last Name:KAMATH
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 1:280 MERCHANTS SQ
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-5029
Mailing Address - Country:US
Mailing Address - Phone:678-813-2741
Mailing Address - Fax:770-575-3912
Practice Address - Street 1:280 MERCHANTS SQ
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-5029
Practice Address - Country:US
Practice Address - Phone:678-813-2741
Practice Address - Fax:770-575-3912
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050392208100000X, 208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH39846Medicare UPIN
GA6883920001Medicare NSC
GA25BBFRFMedicare PIN