Provider Demographics
NPI:1619919750
Name:JAIN, SANJAY RAJ (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:RAJ
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:DR
Other - First Name:SANJAY
Other - Middle Name:RAJ
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:34 UPPER RIVERDALE RD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2635
Mailing Address - Country:US
Mailing Address - Phone:770-996-0622
Mailing Address - Fax:770-996-1492
Practice Address - Street 1:34 UPPER RIVERDALE RD SE
Practice Address - Street 2:SUITE 200
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2635
Practice Address - Country:US
Practice Address - Phone:770-996-0622
Practice Address - Fax:770-996-1492
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227047207RH0003X
GA047455207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology