Healthcare Provider Details

I. General information

NPI: 1154524619
Provider Name (Legal Business Name): ALBANY PRIMARY CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 PALMYRA RD
ALBANY GA
31701-1576
US

IV. Provider business mailing address

2025 PALMYRA RD
ALBANY GA
31701-1576
US

V. Phone/Fax

Practice location:
  • Phone: 229-888-7332
  • Fax: 229-888-2426
Mailing address:
  • Phone: 229-888-7332
  • Fax: 229-888-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number042394
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042394
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042699
License Number StateGA

VIII. Authorized Official

Name: DR. SHYLAJA RRABHAKAR
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 229-888-7332