Provider Demographics
NPI:1609880285
Name:RADMAN, DOUGLAS M (MD)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:M
Last Name:RADMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1875 MILLIKIN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:614-247-8781
Mailing Address - Fax:614-247-6074
Practice Address - Street 1:11459 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-3515
Practice Address - Country:US
Practice Address - Phone:770-497-1555
Practice Address - Fax:770-497-9998
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00792283AMedicaid
G37995Medicare UPIN
GA08BBSQFMedicare ID - Type Unspecified