Provider Demographics
NPI:1285674770
Name:RASSEKH, RIAZ (MD)
Entity type:Individual
Prefix:DR
First Name:RIAZ
Middle Name:
Last Name:RASSEKH
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:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8251
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:2011 WINDSOR SPRING ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906
Practice Address - Country:US
Practice Address - Phone:706-798-1700
Practice Address - Fax:706-798-8626
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACH0654OtherRR MEDICARE GROUP PIN
GA00622927AMedicaid
GA337013OtherWELLCARE
GA10056414OtherAMERIGROUP
GA038923OtherLICENSE
SCG38923Medicaid
GACH0654OtherRR MEDICARE GROUP PIN