Basic Information
| Provider Information | |||||||||
| NPI: | 1902347313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KEMPARAJURS | ||||||||
| FirstName: | SAMYUKTHA | ||||||||
| MiddleName: | VANI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2084 HEADLAND DR | ||||||||
| Address2: | |||||||||
| City: | EAST POINT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303442135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049655691 | ||||||||
| FaxNumber: | 4046981478 | ||||||||
| Practice Location | |||||||||
| Address1: | 2084 HEADLAND DR | ||||||||
| Address2: | |||||||||
| City: | EAST POINT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303442135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4049655691 | ||||||||
| FaxNumber: | 4046981478 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2017 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R4463 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 53626 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 92110 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100569380 | 05 | KY | MEDICAID | K255240 | 01 | KY | MEDICARE | OTHER |