Provider Demographics
NPI:1194781070
Name:RAZIANO, KEITH C (MD)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:C
Last Name:RAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5730 GLENRIDGE DR NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6141
Mailing Address - Country:US
Mailing Address - Phone:404-816-3000
Mailing Address - Fax:678-904-5797
Practice Address - Street 1:5730 GLENRIDGE DR NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-6141
Practice Address - Country:US
Practice Address - Phone:404-816-3000
Practice Address - Fax:678-904-5797
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050988208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1710946322OtherGROUP NPI NUMBER
GA646007054AMedicaid
GA7627358OtherCIGNA
GA646007054AMedicaid
GA1710946322OtherGROUP NPI NUMBER
I20043Medicare UPIN