Provider Demographics
NPI:1902928526
Name:DRS CHANDRAKANTH & NIRMALA AMARAM
Entity Type:Organization
Organization Name:DRS CHANDRAKANTH & NIRMALA AMARAM
Other - Org Name:DRS AMARAM & AMARAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRAKANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-285-2519
Mailing Address - Street 1:302 UVALDA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4551
Mailing Address - Country:US
Mailing Address - Phone:912-285-2519
Mailing Address - Fax:
Practice Address - Street 1:302 UVALDA ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4551
Practice Address - Country:US
Practice Address - Phone:912-285-2519
Practice Address - Fax:912-284-2482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA159002207RN0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000802315BMedicaid
GA000804372DMedicaid
GA000804372EMedicaid
GA000804372AMedicaid
GA000802315BMedicaid
GA000804372AMedicaid
GA000802315BMedicaid
GA000804372EMedicaid
GAG79236Medicare UPIN