Individual
MADHAVA R KOTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1829 LAWRENCEVILLE HWY, DECATUR, GA 30033-5728
(404) 292-8335
Mailing address
1829 LAWRENCEVILLE HWY, DECATUR, GA 30033-5728
(404) 292-8335
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
059812
GA
207R00000X
Internal Medicine Physician
Primary
059812
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001967
LICENSE
NY
01
—
059812
GEORGIA LICENSE
GA
Enumeration date
07/18/2006
Last updated
06/09/2011
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