Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Vijay Kumar Kannam, MD

Individual provider Family Medicine Physician · NPI 1699039610

Dr. Vijay Kumar Kannam, MD is a Family Practice in Gravette, Arkansas. Qualified in 2015, 11 years ago. Practices with Sgoh Acquisition Inc, a 93-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arkansas.

Years since qualifying
11
Licensed in
AR
In the registry since
2012
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1101 Jackson St SW
Gravette, AR 72736-9121
Phone: (479) 787-5221
Fax: (479) 787-5613
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 102 Russell Rd, Rogers, AR 72756-9319 — (479) 278-7189

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence E-9316 (AR)

Record details

NPI number1699039610
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 25, 2012
Last updated in NPPESOctober 16, 2023
Certification dateOctober 16, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Sgoh Acquisition Inc — 93 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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