Individual
DR. VIJAY KUMAR KANNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Mailing address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-9316
AR
Other
Enumeration date
06/25/2012
Last updated
10/16/2023
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