Provider Demographics
NPI:1609809813
Name:VERMA, RAJIV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:VERMA
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:PO BOX 6059
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-6059
Mailing Address - Country:US
Mailing Address - Phone:706-529-9301
Mailing Address - Fax:706-529-9302
Practice Address - Street 1:1600 BROADRICK DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3012
Practice Address - Country:US
Practice Address - Phone:706-529-9301
Practice Address - Fax:706-529-9302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN038950174400000X
GA174400000X
TN38950207RC0000X, 207RC0001X
GA48468207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000911721EMedicaid
GA000911721EMedicaid
GAH39694Medicare UPIN
TN3327833Medicare PIN