Individual
KAVITA VANGURU BOLLAVARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
VA CLINIC, 1970 RIVERSIDE PARKWAY, LAWRENCEVILLE, GA 30043
(404) 417-1713
Mailing address
2224 GLENMORE LN, SNELLVILLE, GA 30078-5650
(770) 985-1870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
047575
GA
Other
Enumeration date
06/27/2006
Last updated
07/08/2007
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