Provider Demographics
NPI:1861082471
Name:KANCHARLA, JITHENDAR
Entity type:Individual
Prefix:MR
First Name:JITHENDAR
Middle Name:
Last Name:KANCHARLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 APOLLO DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5474
Mailing Address - Country:US
Mailing Address - Phone:908-731-1786
Mailing Address - Fax:866-301-3071
Practice Address - Street 1:1840 APOLLO DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5474
Practice Address - Country:US
Practice Address - Phone:908-731-1786
Practice Address - Fax:866-301-3071
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion