NPIMap

Organization Active NPI

Kandallu R Ramesh, MD, PC

  • Otolaryngology Physician
  • Waycross, GA
National Provider Identifier
1699044040
Registry record updated Dec 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
34928 Issued in GA
Legal business name
KANDALLU R RAMESH, MD, PC
Practice address
101 Darling Ave
Waycross, GA 31501-5219
Phone
(912) 287-1297
Fax
(912) 283-6897
NPI assigned
Dec 14, 2011
Last updated
Dec 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2011

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

Authorized official

Name
Dr. Kandallu R Ramesh, M.D.NPI 1801829460
Title
President
Phone
(912) 287-1297

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 34928 GA Primary

Addresses

Primary practice location

101 Darling Ave
Waycross, GA 31501-5219

Mailing address

101 Darling Ave
Waycross, GA 31501-5219
Phone (912) 287-1297

Other identifiers 1

IdentifierTypeStateIssuer
00483062BMedicaidGA

National Provider Directory

National Provider Directory

Locations

101 Darling Ave
Waycross, GA 31501
Phone (912) 287-1297

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323820800000",
    "number": "1699044040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 DARLING AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015219",
            "telephone_number": "912-287-1297",
            "fax_number": "912-283-6897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DARLING AVE",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315015219",
            "telephone_number": "912-287-1297",
            "fax_number": "912-283-6897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANDALLU R RAMESH, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-14",
        "last_updated": "2011-12-14",
        "status": "A",
        "authorized_official_last_name": "RAMESH",
        "authorized_official_first_name": "KANDALLU",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-287-1297",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "GA",
            "license": "34928",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00483062B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waycross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.