Provider Demographics
NPI:1851397368
Name:LOLABHATTU, RAGHU N (MD)
Entity Type:Individual
Prefix:
First Name:RAGHU
Middle Name:N
Last Name:LOLABHATTU
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:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-0845
Mailing Address - Country:US
Mailing Address - Phone:478-272-2599
Mailing Address - Fax:478-272-6441
Practice Address - Street 1:2400 BELLEVUE AVENUE
Practice Address - Street 2:ERIN OFFICE PARK SUITE 19 B
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-272-2599
Practice Address - Fax:478-272-6441
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047617207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00901183CMedicaid
GAH12195Medicare UPIN
GA11BDVPPMedicare ID - Type UnspecifiedMEDICARE