Active NPI
Kannan Vaidyanathan, MD
- Pediatrics Physician
- Dublin, GA
National Provider Identifier
1679584726
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 042965
- Practice address
- 112 Rowe St
Dublin, GA 31021 - Phone
- (478) 272-5212
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 042965 | GA | Primary |
Addresses
Primary practice location
112 Rowe St
Dublin, GA 31021
Mailing address
112 Rowe St
Dublin, GA 31021
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 042965 | GA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fairview Park, Limited Partnership | Past | Accepting new patients | |
| Laurens Pediatrics, LLC | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Dublin, GA
- NPI 1497389795
-
dba Fairview Park Hospital
- General Acute Care Hospital
- Dublin, GA
- NPI 1285688234
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679584726",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 ROWE ST",
"city": "DUBLIN",
"state": "GA",
"postal_code": "31021"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 ROWE ST",
"city": "DUBLIN",
"state": "GA",
"postal_code": "31021",
"telephone_number": "478-272-5212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAIDYANATHAN",
"first_name": "KANNAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "GA",
"license": "042965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dublin, GA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.