Provider Demographics
NPI:1073546487
Name:RAGHAVAN, KALPANA J (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:J
Last Name:RAGHAVAN
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 1:3610 HIGHLANDS PKWY SE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5184
Mailing Address - Country:US
Mailing Address - Phone:770-444-9981
Mailing Address - Fax:770-444-9970
Practice Address - Street 1:3610 HIGHLANDS PKWY SE
Practice Address - Street 2:BUILDING 2
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5184
Practice Address - Country:US
Practice Address - Phone:770-444-9981
Practice Address - Fax:770-444-9970
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000613808EMedicaid
GA000613808DMedicaid
GA000613808DMedicaid
160055637Medicare PIN
GA000613808EMedicaid