Provider Demographics
NPI:1669498192
Name:S RAO CHETI PC
Entity Type:Organization
Organization Name:S RAO CHETI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:CHETI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-474-8781
Mailing Address - Street 1:4778 N HENRY BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-3566
Mailing Address - Country:US
Mailing Address - Phone:404-474-8781
Mailing Address - Fax:404-474-8670
Practice Address - Street 1:4778 N HENRY BLVD STE 202
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3566
Practice Address - Country:US
Practice Address - Phone:404-474-8781
Practice Address - Fax:404-474-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG41769Medicare UPIN
GA11SCFBWMedicare ID - Type UnspecifiedMEDICARE