Individual
ANITHA KANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
198 S HOUSTON LAKE RD STE B, WARNER ROBINS, GA 31088-6475
(478) 971-1500
(478) 971-2112
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1927
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207784733C
—
GA
Enumeration date
04/17/2007
Last updated
02/01/2023
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