Provider Demographics
NPI:1184823650
Name:RANGARAJ, RAMYA NAGARAJAN (MD)
Entity Type:Individual
Prefix:
First Name:RAMYA
Middle Name:NAGARAJAN
Last Name:RANGARAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAMYA
Other - Middle Name:
Other - Last Name:NAGARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4415 FRONT NINE DR STE 700
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6239
Mailing Address - Country:US
Mailing Address - Phone:678-456-8782
Mailing Address - Fax:678-456-8814
Practice Address - Street 1:4415 FRONT NINE DR STE 700
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6239
Practice Address - Country:US
Practice Address - Phone:678-456-8782
Practice Address - Fax:678-456-8814
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA646802081P2900X, 208VP0000X, 208VP0014X
MI4301090209208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003120613AMedicaid
GA003120613BMedicaid
GA003120613EMedicaid
GA003120613FMedicaid
GA003120613CMedicaid
GA003120613DMedicaid
GA003120613FMedicaid