Provider Demographics
NPI:1548527450
Name:KOGANTI, DEEPIKA
Entity type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:
Last Name:KOGANTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 JESSE HILL JR. DRIVE, SW
Mailing Address - Street 2:GLENN MEMORIAL BLDG 3RD FL
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-251-8915
Mailing Address - Fax:
Practice Address - Street 1:69 JESSE HILL JR. DRIVE, SW
Practice Address - Street 2:GLENN MEMORIAL BLDG 3RD FL
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA809872086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care