Provider Demographics
NPI:1467912378
Name:RAO, VINDHYA (DO)
Entity Type:Individual
Prefix:
First Name:VINDHYA
Middle Name:
Last Name:RAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 TOWN BOULEVARD
Mailing Address - Street 2:SUITE 590
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319
Mailing Address - Country:US
Mailing Address - Phone:404-251-1940
Mailing Address - Fax:404-869-1635
Practice Address - Street 1:705 TOWN BOULEVARD
Practice Address - Street 2:SUITE 590
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319
Practice Address - Country:US
Practice Address - Phone:404-251-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92377207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine