Provider Demographics
NPI:1215047014
Name:SAMRAJ, JOSHUA S (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:S
Last Name:SAMRAJ
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 1:2000 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1638
Mailing Address - Country:US
Mailing Address - Phone:706-653-2226
Mailing Address - Fax:706-653-2228
Practice Address - Street 1:2000 12TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1638
Practice Address - Country:US
Practice Address - Phone:706-653-2226
Practice Address - Fax:706-653-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000880558CMedicaid
GA200678941OtherTRICARE PROVIDER NUMBER
GA900226966OtherRAILROAD MEDICARE NUMBER
GA923658OtherBCBS GEORGIA PIN NUMBER
GA900226966OtherRAILROAD MEDICARE NUMBER
GA000880558CMedicaid
GAG22871Medicare UPIN