Provider Demographics
NPI:1124191200
Name:GOKARNESAN NATARAJAN MD PC
Entity Type:Organization
Organization Name:GOKARNESAN NATARAJAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GOKARNESAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NATARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-4436
Mailing Address - Street 1:528 VALLEY HILL RD SW
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2441
Mailing Address - Country:US
Mailing Address - Phone:770-996-4436
Mailing Address - Fax:770-996-0490
Practice Address - Street 1:528 VALLEY HILL RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2441
Practice Address - Country:US
Practice Address - Phone:770-996-4436
Practice Address - Fax:770-996-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032623207X00000X
GA032660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1853Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER