Provider Demographics
NPI:1033167333
Name:RAVINDRAN, PRIYA DHARSHINI (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:DHARSHINI
Last Name:RAVINDRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-854-6008
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-5795
Practice Address - Fax:706-774-5792
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA064449207RG0100X
GA64449207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003100276AMedicaid
MOP00427208Medicare PIN
GA003100276AMedicaid
I36751Medicare UPIN
MO933291879Medicare PIN
MO933295236Medicare PIN
MOP00290598Medicare PIN