Basic Information
| Provider Information | |||||||||
| NPI: | 1043662463 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANDIAH | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1139 LEXINGTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314045502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123034200 | ||||||||
| FaxNumber: | 9127902701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1139 LEXINGTON AVE STE A | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314045502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123034200 | ||||||||
| FaxNumber: | 9127902701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2016 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 92138 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.