Provider Demographics
NPI:1790720852
Name:JAYARAJ, HARIYEBBE C (MD PC)
Entity Type:Individual
Prefix:
First Name:HARIYEBBE
Middle Name:C
Last Name:JAYARAJ
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5538
Mailing Address - Country:US
Mailing Address - Phone:478-929-4432
Mailing Address - Fax:478-922-7109
Practice Address - Street 1:1205 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5538
Practice Address - Country:US
Practice Address - Phone:478-929-4432
Practice Address - Fax:478-922-7109
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020746207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1790720852OtherNPI
GA00188097AMedicaid
GA00188097AMedicaid