Provider Demographics
NPI:1780863324
Name:SAMRAJ MEDICAL CLINIC, P.C.
Entity Type:Organization
Organization Name:SAMRAJ MEDICAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAMRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-653-2226
Mailing Address - Street 1:2000 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1638
Mailing Address - Country:US
Mailing Address - Phone:706-653-2226
Mailing Address - Fax:706-653-2228
Practice Address - Street 1:2000 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1638
Practice Address - Country:US
Practice Address - Phone:706-653-2226
Practice Address - Fax:706-653-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046322261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7206OtherMEDICARE GROUP ID
GA297594OtherWELLCARE
GAP00226966OtherRR MEDICARE
FLDD4216OtherMEDICARE RAILROAD CARRIER
GA000880558CMedicaid
GA923658OtherBCBS
GAP00226966OtherRR MEDICARE
GA=========OtherTRICARE
GA000880558CMedicaid