Individual
DR. CHUDAMANI RAO POLKAMPALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
225 COUNTRY CLUB DR STE 140, STOCKBRIDGE, GA 30281-7392
(770) 415-5889
(770) 415-5890
Mailing address
225 COUNTRY CLUB DR STE 140, STOCKBRIDGE, GA 30281-7392
(770) 415-5889
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
57.009009
OH
207RN0300X
Nephrology Physician
Primary
74563
GA
207RN0300X
Nephrology Physician
P8066
TX
390200000X
Student in an Organized Health Care Education/Training Program
0101241347
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339316701
—
TX
01
—
P01393816
RRMDCR
TX
Enumeration date
10/06/2006
Last updated
04/30/2020
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