Provider Demographics
NPI:1407089410
Name:SOOD, RAJIV (DO)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:SOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1287 GA-138 SPUR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:770-473-0038
Mailing Address - Fax:770-471-4290
Practice Address - Street 1:1287 GEORGIA HIGHWAY 138 SPUR ROAD
Practice Address - Street 2:SUITE #8
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-473-0038
Practice Address - Fax:770-471-4290
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2015-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLUO2219208D00000X
GA0724422081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLUO2219Medicare UPIN