Provider Demographics
NPI:1891361655
Name:RAVILLA, LOKDHEERAJ (MD)
Entity Type:Individual
Prefix:
First Name:LOKDHEERAJ
Middle Name:
Last Name:RAVILLA
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 1:2655 BLACKSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1957
Mailing Address - Country:US
Mailing Address - Phone:770-877-1806
Mailing Address - Fax:
Practice Address - Street 1:2655 BLACKSTOCK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-1957
Practice Address - Country:US
Practice Address - Phone:770-877-1806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA128212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry