Provider Demographics
NPI:1841381696
Name:RAO, SANJEEVA H (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEVA
Middle Name:H
Last Name:RAO
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 1:232 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:770-775-2787
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:770-775-2787
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018723GA173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00299989AMedicaid
GRP3244Medicare PIN
CK2774Medicare PIN