Provider Demographics
NPI:1316921059
Name:PRASAD, RAYASAM V (MD)
Entity type:Individual
Prefix:DR
First Name:RAYASAM
Middle Name:V
Last Name:PRASAD
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 1:1520 ROCK QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7386
Mailing Address - Country:US
Mailing Address - Phone:770-474-7800
Mailing Address - Fax:770-474-0608
Practice Address - Street 1:1520 ROCK QUARRY RD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7386
Practice Address - Country:US
Practice Address - Phone:770-474-7800
Practice Address - Fax:770-474-0608
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020795174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40896Medicare UPIN
GA23604942AMedicare ID - Type Unspecified