Provider Demographics
NPI:1255370375
Name:RAO, GEETHA SHIVA (MD)
Entity type:Individual
Prefix:
First Name:GEETHA
Middle Name:SHIVA
Last Name:RAO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:255 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2531
Mailing Address - Country:US
Mailing Address - Phone:770-907-0554
Mailing Address - Fax:770-907-9048
Practice Address - Street 1:1255 HIGHWAY 54 W
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4526
Practice Address - Country:US
Practice Address - Phone:770-719-5850
Practice Address - Fax:770-719-5849
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-05-22
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Provider Licenses
StateLicense IDTaxonomies
GA541152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH19134Medicare UPIN