Provider Demographics
NPI:1588619639
Name:PADHIAR, DHANRAJ N (MD)
Entity Type:Individual
Prefix:
First Name:DHANRAJ
Middle Name:N
Last Name:PADHIAR
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 1:207 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1859
Mailing Address - Country:US
Mailing Address - Phone:229-242-5050
Mailing Address - Fax:229-242-0716
Practice Address - Street 1:207 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1859
Practice Address - Country:US
Practice Address - Phone:229-242-5050
Practice Address - Fax:229-242-0716
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022615207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85001169GMedicaid
GA85001169GMedicaid
GAGRP648Medicare ID - Type Unspecified