Active NPI
Jithender R Kandimalla, MD
- Surgery Physician
- Griffin, GA
National Provider Identifier
1891748539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 072654
- Practice address
- 619 S 8TH St Ste 301
Griffin, GA 30224-4260 - Phone
- (770) 229-6072
- Fax
- (770) 229-2111
- NPI assigned
- May 17, 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 52678 | MN | |
| Surgery Physician | 208600000X | 9950 | ND | |
| Surgery Physician | 208600000X | 072654 | GA | Primary |
Addresses
Primary practice location
619 S 8TH St Ste 301
Griffin, GA 30224-4260
Mailing address
655 Will St
Griffin, GA 30224-4236
Phone (770) 229-6072
Other practice location 1
655 Will St
Griffin, GA 30224-4236
Phone (770) 229-6072
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jkandimalla123308@directwellstar.org |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52678 | MN | MD | Surgery Physician |
| 9950 | ND | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571270400000",
"number": "1891748539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 WILL ST",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "302244236",
"telephone_number": "770-229-6072",
"fax_number": "770-229-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "619 S 8TH ST STE 301",
"city": "GRIFFIN",
"state": "GA",
"postal_code": "302244260",
"telephone_number": "770-229-6072",
"fax_number": "770-229-2111"
}
],
"practiceLocations": [
{
"address_1": "655 Will St",
"address_purpose": "LOCATION",
"city": "Griffin",
"state": "GA",
"postal_code": "302244236",
"country_code": "US",
"telephone_number": "770-229-6072",
"fax_number": "770-229-2111",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KANDIMALLA",
"first_name": "JITHENDER",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2019-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MN",
"license": "52678",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ND",
"license": "9950",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "GA",
"license": "072654",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jkandimalla123308@directwellstar.org",
"affiliation": "N",
"address_1": "619 S 8th St Ste 301",
"city": "Griffin",
"state": "GA",
"country_code": "US",
"postal_code": "302244260",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Griffin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.