Kavita Vanguru Bollavaram, M.D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

047575 Issued in GA

Practice address

VA Clinic
1970 Riverside Parkway
Lawrenceville, GA 30043

Phone

(404) 417-1713

NPI assigned

Jun 27, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366479982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2224 GLENMORE LN",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785650",
            "telephone_number": "770-985-1870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "VA CLINIC",
            "address_2": "1970 RIVERSIDE PARKWAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30043",
            "telephone_number": "404-417-1713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLAVARAM",
        "first_name": "KAVITA",
        "middle_name": "VANGURU",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "047575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine H Boggs, LCSW
• John G Bojack, CRNA
• Bold Steps ABA of Ga LLC
• Bolen Chiropractic, Inc.
• Angela Y Bolger, CRNP
• Bolt Eye Group - Lawrenceville LLC
• Katherine Bonas, M.ED., CCC-SLP
• Pauline Carmela Bondoc-Roaquin, P.T.
• Joan Boneberg, M.S.
• Alahni Bones

• Internal Medicine Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.