Provider Demographics
NPI:1265850465
Name:RAJANAHALLY, SANEAL
Entity Type:Individual
Prefix:
First Name:SANEAL
Middle Name:
Last Name:RAJANAHALLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 COUNTRY CLUB DR STE 100
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:770-474-5281
Mailing Address - Fax:770-389-8674
Practice Address - Street 1:290 COUNTRY CLUB DR STE 100
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9069
Practice Address - Country:US
Practice Address - Phone:770-474-5281
Practice Address - Fax:770-389-8674
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85582208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology