Provider Demographics
NPI:1073603353
Name:PAUL INTERNAL MEDICINE
Entity Type:Organization
Organization Name:PAUL INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-623-0008
Mailing Address - Street 1:3245 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE D-170
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6008
Mailing Address - Country:US
Mailing Address - Phone:770-623-0008
Mailing Address - Fax:770-623-0009
Practice Address - Street 1:4355 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6085
Practice Address - Country:US
Practice Address - Phone:770-623-0008
Practice Address - Fax:770-623-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA801250932AMedicaid
GAGRP6956Medicare ID - Type Unspecified
GA801250932AMedicaid