Provider Demographics
NPI:1376018689
Name:ATULO, RAPHAEL ASWANI (PA)
Entity type:Individual
Prefix:MR
First Name:RAPHAEL
Middle Name:ASWANI
Last Name:ATULO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1019 RUTH CREEK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2328
Mailing Address - Country:US
Mailing Address - Phone:706-393-4758
Mailing Address - Fax:
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-320-8750
Practice Address - Fax:706-320-8770
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA009037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant