1033100797 NPI number — MEENAKSHI HEMA KAKARALA MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033100797 NPI number — MEENAKSHI HEMA KAKARALA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAKARALA
Provider First Name:
MEENAKSHI
Provider Middle Name:
HEMA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAKARALA
Provider Other First Name:
MEENA
Provider Other Middle Name:
HEMA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033100797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
790 CHURCH ST NE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30060-7282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-797-8201
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 CHURCH ST NE
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30060-7282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-797-8201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME80724 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 61974 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 260861800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2508903 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3764898001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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