Provider Demographics
NPI:1780817288
Name:SURANA, JAI (MD)
Entity type:Individual
Prefix:DR
First Name:JAI
Middle Name:
Last Name:SURANA
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 1:707 CENTER ST STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1575
Mailing Address - Country:US
Mailing Address - Phone:706-494-4300
Mailing Address - Fax:706-660-2847
Practice Address - Street 1:500 18TH ST STE A30
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1535
Practice Address - Country:US
Practice Address - Phone:706-571-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74501207RP1001X
OK30522207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200541870AMedicaid
OK200541870AMedicaid