Provider Demographics
NPI:1760470892
Name:RAJU, SUNDARI (MD)
Entity Type:Individual
Prefix:MRS
First Name:SUNDARI
Middle Name:
Last Name:RAJU
Suffix:
Gender:F
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:PO BOX 158
Mailing Address - Street 2:126 EAST BROAD STREET
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815
Mailing Address - Country:US
Mailing Address - Phone:229-838-0885
Mailing Address - Fax:229-838-0887
Practice Address - Street 1:126 EAST BROAD STREET
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815
Practice Address - Country:US
Practice Address - Phone:229-838-0885
Practice Address - Fax:229-838-0887
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040199207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1625183OtherFIRST HEALTH
P00174258OtherRAILROAD MEDICARE
GA000680699FMedicaid
1379773OtherCIGNA
0101742OtherUNITED HEALTHCARE
52596864001OtherBCBS GA
450491390RAJ1OtherEVERGREEN
60027561OtherBCBS AL
GA000680699FMedicaid
GA08CBBSJMedicare PIN
P00174258OtherRAILROAD MEDICARE
0101742OtherUNITED HEALTHCARE