Provider Demographics
NPI:1629371497
Name:VISITING PHYSICIAN CARE
Entity Type:Organization
Organization Name:VISITING PHYSICIAN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATAPPA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANGARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-218-3468
Mailing Address - Street 1:230 WYTHEFORD CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5082
Mailing Address - Country:US
Mailing Address - Phone:513-218-3468
Mailing Address - Fax:770-406-1058
Practice Address - Street 1:5675 JIMMY CARTER BLVD
Practice Address - Street 2:SUITE #K
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2965
Practice Address - Country:US
Practice Address - Phone:770-744-7688
Practice Address - Fax:770-406-1058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058633261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care