Provider Demographics
NPI:1538128079
Name:MAKADIA, RAKESH (MD)
Entity Type:Individual
Prefix:
First Name:RAKESH
Middle Name:
Last Name:MAKADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 MAXWELL RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2064
Mailing Address - Country:US
Mailing Address - Phone:770-274-0473
Mailing Address - Fax:
Practice Address - Street 1:330 TURNER MCCALL BLVD SW STE 201
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5634
Practice Address - Country:US
Practice Address - Phone:706-509-4340
Practice Address - Fax:706-291-2147
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59275207R00000X
ARE4721207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I50133Medicare UPIN
AR5N485Medicare ID - Type Unspecified