Individual
JEEVITH R KANUKUNTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3333 JODECO ROAD, SUITE A, MCDONOUGH, GA 30253
(770) 692-4000
(770) 474-8510
Mailing address
3333 JODECO ROAD, SUITE A, MCDONOUGH, GA 30253
(770) 692-4000
(770) 474-8510
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
52755
GA
207RC0000X
Cardiovascular Disease Physician
52755
GA
207RI0011X
Interventional Cardiology Physician
Primary
52755
GA
Other
Enumeration date
06/01/2006
Last updated
02/22/2024
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