Provider Demographics
NPI:1851387245
Name:DHALIWAL, RANJIT S (MD)
Entity Type:Individual
Prefix:MR
First Name:RANJIT
Middle Name:S
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3520 WALTON WAY EXT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6605
Mailing Address - Country:US
Mailing Address - Phone:706-481-9191
Mailing Address - Fax:706-481-9197
Practice Address - Street 1:3520 WALTON WAY EXT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6605
Practice Address - Country:US
Practice Address - Phone:706-481-9191
Practice Address - Fax:706-481-9197
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038466207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00616943FMedicaid
SCG38466Medicaid
GA00616943FMedicaid
SCG38466Medicaid