Provider Demographics
NPI:1790706596
Name:MINIYAR, RAJESHKUMAR MOTILAL (MD)
Entity Type:Individual
Prefix:MR
First Name:RAJESHKUMAR
Middle Name:MOTILAL
Last Name:MINIYAR
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 1:140 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4999
Mailing Address - Country:US
Mailing Address - Phone:706-232-1300
Mailing Address - Fax:706-232-1039
Practice Address - Street 1:711 SHIELDS RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5013
Practice Address - Country:US
Practice Address - Phone:706-278-6628
Practice Address - Fax:706-278-6650
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000954346BMedicaid
GA299653708AMedicaid