Individual
PUVALAI VIJAYKUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1707 WATSON BLVD, WARNER ROBINS, GA 31093-3606
(478) 929-8030
(478) 929-8095
Mailing address
1707 WATSON BLVD, WARNER ROBINS, GA 31093-3606
(478) 929-8030
(478) 929-8095
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
18484
WV
207RC0000X
Cardiovascular Disease Physician
35071686V
OH
207RC0000X
Cardiovascular Disease Physician
MD041441E
PA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
084192
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011803240001
—
PA
05
—
0011803240008
—
PA
05
—
0086343000
—
WV
05
—
0188229
—
OH
Enumeration date
10/07/2005
Last updated
01/20/2020
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