1053725408 NPI number — DR. LINDA CHACKO KUZHIPPALA M.D.

Table of content: DR. LINDA CHACKO KUZHIPPALA M.D. (NPI 1053725408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053725408 NPI number — DR. LINDA CHACKO KUZHIPPALA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUZHIPPALA
Provider First Name:
LINDA
Provider Middle Name:
CHACKO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHACKO
Provider Other First Name:
LINDA
Provider Other Middle Name:
THOMAS
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053725408
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 MANSELL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30076-1507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-521-2229
Provider Business Mailing Address Fax Number:
770-521-2231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 MANSELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-521-2229
Provider Business Practice Location Address Fax Number:
770-521-2231
Provider Enumeration Date:
06/13/2014

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: 207V00000X , with the licence number:  81462 , 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)





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