Provider Demographics
NPI:1114999257
Name:PRATURI, RAJASREE (MD)
Entity Type:Individual
Prefix:
First Name:RAJASREE
Middle Name:
Last Name:PRATURI
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 1:1731 MERIWEATHER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-3046
Mailing Address - Country:US
Mailing Address - Phone:706-227-7204
Mailing Address - Fax:706-227-7225
Practice Address - Street 1:465 WINN WAY STE 221
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1723
Practice Address - Country:US
Practice Address - Phone:404-292-3810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0499352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDJZJMedicare ID - Type Unspecified
GAG27947Medicare UPIN