Provider Demographics
NPI:1760467005
Name:PENDARVIS, RANIE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RANIE
Middle Name:WILLIAM
Last Name:PENDARVIS
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 1:3107 WATSONS BND
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8825
Mailing Address - Country:US
Mailing Address - Phone:678-691-0487
Mailing Address - Fax:
Practice Address - Street 1:3107 WATSONS BND
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8825
Practice Address - Country:US
Practice Address - Phone:678-691-0487
Practice Address - Fax:678-691-0487
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV156282085R0202X
IL0361106962085R0202X
FLME845452085R0202X
OK241452085R0202X
GA0468032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I301648Medicare PIN
GA202I301652Medicare PIN