Background: Immunization is a cornerstone of public health, crucial in preventing childhood diseases. This study assesses immunization coverage and determinants among children enrolled in Anganwadi centers in rural South India, addressing the challenges faced in achieving complete vaccination. Methods: A community-based cross-sectional study was conducted with 400 children under six years, using immunization records from Anganwadi workers. Children were classified as fully immunized if they received all required vaccines by their first birthday. Statistical analyses were performed using SPSS, employing descriptive statistics and Chi-square tests to evaluate associations between sociodemographic factors and immunization status. Results: Among the children, 368 (92%) were fully immunized, while 32 (8%) were partially immunized. Significant associations were found between immunization status and parental education. The availability of immunization cards also correlated strongly with full immunization. The immunization coverage results show high compliance across vaccines, with 100% coverage for BCG and OPV-0 at birth, strong rates (over 97%) for most early and follow-up doses, and slightly lower coverage for booster doses, particularly DPT and OPV boosters.The primary reasons for partial immunization included inadequate knowledge (75%) and health-related issues at vaccination time (18.75%). Discussion: The study highlights the high immunization rates among children in Anganwadi centers, aligning with national data while identifying barriers such as lack of awareness and misconceptions about vaccines. Parental literacy was a significant determinant, indicating the necessity for educational interventions aimed at enhancing knowledge and promoting adherence to vaccination schedules. Conclusion: While immunization coverage is commendable, efforts must focus on addressing knowledge gaps and misconceptions to improve overall vaccination rates. Community engagement and educational initiatives targeting parents are essential for sustaining and enhancing immunization coverage among children in rural areas.