Healthcare Provider Details

I. General information

NPI: 1609052695
Provider Name (Legal Business Name): RAJAT GHAIY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2008
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 CUMBERLAND BLVD SE STE 900
ATLANTA GA
30339-5971
US

IV. Provider business mailing address

3225 CUMBERLAND BLVD SE STE 900
ATLANTA GA
30339-6407
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-2220
  • Fax: 404-352-5392
Mailing address:
  • Phone: 404-351-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number62986
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number062986
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License Number062986
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: