Provider Demographics
NPI:1285627265
Name:FLOREA, RADIAN I (MD)
Entity type:Individual
Prefix:
First Name:RADIAN
Middle Name:I
Last Name:FLOREA
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 1:100 GROSS CRESCENT CIR
Mailing Address - Street 2:
Mailing Address - City:FT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3643
Mailing Address - Country:US
Mailing Address - Phone:706-858-2101
Mailing Address - Fax:
Practice Address - Street 1:2525 DESALES AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1161
Practice Address - Country:US
Practice Address - Phone:423-495-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049171207R00000X
TN41259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00895881BMedicaid
GA7622393OtherAETNA
TN4084448OtherBCBS OF TENNESSEE
GA52676663OtherBCBS OF GEORGIA
GAH31579Medicare UPIN
GA52676663OtherBCBS OF GEORGIA