Provider Demographics
NPI:1063053528
Name:ATTAWALA, RAUHA
Entity type:Individual
Prefix:
First Name:RAUHA
Middle Name:
Last Name:ATTAWALA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 CRESTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8146
Mailing Address - Country:US
Mailing Address - Phone:770-912-7201
Mailing Address - Fax:
Practice Address - Street 1:755 LAWRENCEVILLE SUWANEE RD STE 1600
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7345
Practice Address - Country:US
Practice Address - Phone:770-995-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033509363A00000X
CAPA65443363A00000X
GA9463363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant