Active NPI
Jahnavi Kandepu
- Neurology with Special Qualifications in Child Neurology Physician
- Augusta, GA
National Provider Identifier
1063084580
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology with Special Qualifications in Child Neurology Physician
- License
- 13482
- Practice address
- 1475 Laney Walker Blvd
Augusta, GA 30912-0002 - Phone
- (706) 721-7005
- NPI assigned
- Jul 14, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | 13482 | GA | Primary |
Addresses
Primary practice location
1475 Laney Walker Blvd
Augusta, GA 30912-0002
Mailing address
370 Front St Unit 319
North Augusta, SC 29841-4378
Phone (813) 940-9340
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210802000599 | GA | Order and Referring Only - Pediatric Medicine | 9234533043 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13482 | GA | MD | Neurology with Special Qualifications in Child Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1626220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626220800000",
"number": "1063084580",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "370 FRONT ST UNIT 319",
"city": "NORTH AUGUSTA",
"state": "SC",
"postal_code": "298414378",
"telephone_number": "813-940-9340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 LANEY WALKER BLVD",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309120002",
"telephone_number": "706-721-7005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANDEPU",
"first_name": "JAHNAVI",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-14",
"last_updated": "2021-07-14",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0402X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
"state": "GA",
"license": "13482",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Augusta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.