Provider Demographics
NPI:1467659375
Name:RAJA A. ATIYAH, MD PC
Entity Type:Organization
Organization Name:RAJA A. ATIYAH, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJA
Authorized Official - Middle Name:ATA
Authorized Official - Last Name:ATIYAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:931-766-7775
Mailing Address - Street 1:1310 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-2208
Mailing Address - Country:US
Mailing Address - Phone:931-766-7775
Mailing Address - Fax:931-766-7792
Practice Address - Street 1:1310 N LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-2208
Practice Address - Country:US
Practice Address - Phone:931-766-7775
Practice Address - Fax:931-766-7792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAJA A. ATIYAH MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-03
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39510207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3729182Medicare PIN