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NPI Code Detail

MEDICARE: DR. AJAY KUMAR RAVI M.D.

MEDICARE: DR. AJAY KUMAR RAVI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD.203359LA
22085R0202XDiagnostic Radiology Physician27363OK
32085R0204XVascular & Interventional Radiology Physician69938GA
42085R0202XDiagnostic Radiology Physician69938GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063533149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AJAY KUMAR RAVI M.D.
Provider Business Mailing Address
First Line : PO BOX 742616
Second Line :
City : ATLANTA
State : GA
Zip : 30374-2616
Country : US
Telephone Number : 770-219-8420
Fax Number :
Provider Business Practice Location Address
First Line : 743 SPRING ST NE
Second Line :
City : GAINESVILLE
State : GA
Zip : 30501-3715
Country : US
Telephone Number : 770-219-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 12/01/2025

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