Provider Demographics
NPI:1013916576
Name:BARANWAL, AKHIL (MD)
Entity Type:Individual
Prefix:DR
First Name:AKHIL
Middle Name:
Last Name:BARANWAL
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 1:1105 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3409
Mailing Address - Country:US
Mailing Address - Phone:912-393-5051
Mailing Address - Fax:954-301-6333
Practice Address - Street 1:1105 LEE AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3409
Practice Address - Country:US
Practice Address - Phone:912-393-5051
Practice Address - Fax:954-301-6333
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051294207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00964697AMedicaid
GAH62976Medicare UPIN
GA00964697AMedicaid