Provider Demographics
NPI:1194820274
Name:LOUTOBY, RAPHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:G
Last Name:LOUTOBY
Suffix:
Gender:M
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:PO BOX 52725
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-0725
Mailing Address - Country:US
Mailing Address - Phone:404-733-1170
Mailing Address - Fax:404-733-1172
Practice Address - Street 1:870 NORTHSIDE DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5763
Practice Address - Country:US
Practice Address - Phone:404-733-1170
Practice Address - Fax:404-733-1172
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039853207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology