Provider Demographics
NPI:1285894188
Name:RAJU, NAGAMALAR (MD)
Entity type:Individual
Prefix:
First Name:NAGAMALAR
Middle Name:
Last Name:RAJU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 J L WHITE DR
Mailing Address - Street 2:SUITE 110A
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4908
Mailing Address - Country:US
Mailing Address - Phone:706-299-2220
Mailing Address - Fax:706-253-2226
Practice Address - Street 1:1020 J L WHITE DR
Practice Address - Street 2:SUITE 110A
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4908
Practice Address - Country:US
Practice Address - Phone:706-299-2220
Practice Address - Fax:706-253-2226
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA065786207R00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1285894188OtherNPI