Provider Demographics
NPI:1306030416
Name:RALPH D'AURIA, MD, PC
Entity type:Organization
Organization Name:RALPH D'AURIA, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AURIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-378-8002
Mailing Address - Street 1:1452 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1526
Mailing Address - Country:US
Mailing Address - Phone:404-378-8002
Mailing Address - Fax:404-378-6226
Practice Address - Street 1:1452 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1526
Practice Address - Country:US
Practice Address - Phone:404-378-8002
Practice Address - Fax:404-378-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028525208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3227Medicare PIN
GAD29245Medicare UPIN