Provider Demographics
NPI:1205828696
Name:KUMAR, RAKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:KUMAR
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 4150
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-4150
Mailing Address - Country:US
Mailing Address - Phone:706-485-2621
Mailing Address - Fax:706-485-9354
Practice Address - Street 1:123 SPARTA HWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6093
Practice Address - Country:US
Practice Address - Phone:706-485-2621
Practice Address - Fax:706-485-9354
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00229226AMedicaid
GA020000895OtherMCARE RAILROAD
GA017280OtherBCBS OF GA
GA00229226AMedicaid
GAGRP2689Medicare PIN