Provider Demographics
NPI:1992433890
Name:FAIRCLOTH, RAJINI E (MD)
Entity type:Individual
Prefix:DR
First Name:RAJINI
Middle Name:E
Last Name:FAIRCLOTH
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 1:320 ZEAGLER DR STE C
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-6851
Mailing Address - Country:US
Mailing Address - Phone:386-325-9600
Mailing Address - Fax:
Practice Address - Street 1:320 ZEAGLER DR STE C
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-6851
Practice Address - Country:US
Practice Address - Phone:386-325-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHSE36402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty