Provider Demographics
NPI:1760573216
Name:SANJEEVA RAO MD PC
Entity Type:Organization
Organization Name:SANJEEVA RAO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJEEVA
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-775-4334
Mailing Address - Street 1:232 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1907
Mailing Address - Country:US
Mailing Address - Phone:770-775-4334
Mailing Address - Fax:770-775-7573
Practice Address - Street 1:232 W 2ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1907
Practice Address - Country:US
Practice Address - Phone:770-775-4334
Practice Address - Fax:770-775-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018723GA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00299989AMedicaid
GA00299989AMedicaid
GAGRP3244Medicare PIN