Individual
YULIANTY D. KUSUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6413 WATERS AVE, SUITE 102, SAVANNAH, GA 31406-2711
(912) 349-6624
(912) 354-4694
Mailing address
6413 WATERS AVE, SUITE 102, SAVANNAH, GA 31406-2711
(912) 349-6624
(912) 354-4694
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
061279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007011626A
—
GA
01
—
01279332
AMERIGROUP
—
01
—
469648
WELLCARE
GA
01
—
52233988
BCBS
GA
05
—
G61279
—
SC
01
—
P00649653
RR MEDICARE
GA
01
—
P01048571
RAILROAD MEDICARE
GA
Enumeration date
09/13/2007
Last updated
08/25/2015
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