Healthcare Provider Details

I. General information

NPI: 1447996368
Provider Name (Legal Business Name): AVINASH RAYAVARAPU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

101 NE 53RD ST APT 2218
OKLAHOMA CITY OK
73105-1870
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-9250
  • Fax:
Mailing address:
  • Phone: 405-655-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number111022
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: