Provider Demographics
NPI:1376659383
Name:LINGAM, NAGABHUSHANA RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:NAGABHUSHANA RAO
Middle Name:
Last Name:LINGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAO
Other - Middle Name:N
Other - Last Name:LINGAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:104 ROYAL BURGESS WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4232
Mailing Address - Country:US
Mailing Address - Phone:770-389-4647
Mailing Address - Fax:478-274-5511
Practice Address - Street 1:1826 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3620
Practice Address - Country:US
Practice Address - Phone:478-272-1210
Practice Address - Fax:478-274-5511
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018820208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD 70545Medicare UPIN