Healthcare Provider Details

I. General information

NPI: 1558694984
Provider Name (Legal Business Name): RAJUL PANDYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD
ATLANTA GA
30342-1606
US

IV. Provider business mailing address

5605 GLENRIDGE DR STE 325
ATLANTA GA
30342-1301
US

V. Phone/Fax

Practice location:
  • Phone: 48-516-3234
  • Fax:
Mailing address:
  • Phone: 404-252-4709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.098152
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number89452
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: