Healthcare Provider Details

I. General information

NPI: 1184621971
Provider Name (Legal Business Name): RAJANI SOPAN CHAUDHARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 NORTH AVE NE
ATLANTA GA
30308-2504
US

IV. Provider business mailing address

402 NORTH AVE NE
ATLANTA GA
30308-2504
US

V. Phone/Fax

Practice location:
  • Phone: 404-873-1894
  • Fax: 404-873-6487
Mailing address:
  • Phone: 404-873-1894
  • Fax: 404-873-6487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number023340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: