Provider Demographics
NPI:1053464255
Name:SADRUDIN J SARANGI, MD.,PC
Entity Type:Organization
Organization Name:SADRUDIN J SARANGI, MD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SADRUDIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SARANGI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:770-991-1600
Mailing Address - Street 1:150 MEDICAL WAY
Mailing Address - Street 2:SUITE B 1
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2533
Mailing Address - Country:US
Mailing Address - Phone:770-991-1600
Mailing Address - Fax:770-991-1616
Practice Address - Street 1:150 MEDICAL WAY
Practice Address - Street 2:SUITE B 1
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2533
Practice Address - Country:US
Practice Address - Phone:770-991-1600
Practice Address - Fax:770-991-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018546207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000136969BMedicaid
GAGRP7432Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
GAD41051Medicare UPIN
GA385689521AMedicare ID - Type UnspecifiedPROVIDER NUMBER