Healthcare Provider Details

I. General information

NPI: 1205065604
Provider Name (Legal Business Name): RAJIV M TEJURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY STE A510
ALPHARETTA GA
30005-3750
US

IV. Provider business mailing address

3400 OLD MILTON PKWY STE A510
ALPHARETTA GA
30005-3750
US

V. Phone/Fax

Practice location:
  • Phone: 470-291-0605
  • Fax: 470-297-0418
Mailing address:
  • Phone: 470-291-0605
  • Fax: 470-297-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68804
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: