Individual
DR. CHADALAVADA N KISHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
425 THIRD AVE, STE 340, ALBANY, GA 31701
(229) 312-9150
(229) 435-5590
Mailing address
PO BOX 84009, COLUMBUS, GA 31908-4009
(229) 312-5800
(229) 312-5853
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
27846
GA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
027846
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000312881C
—
GA
05
—
00312881A
—
GA
Enumeration date
08/25/2005
Last updated
11/01/2010
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