Healthcare Provider Details

I. General information

NPI: 1790780278
Provider Name (Legal Business Name): ISRAEL B ORIJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 MULKEY RD STE 5A
AUSTELL GA
30106-1122
US

IV. Provider business mailing address

1790 MULKEY RD STE 5A
AUSTELL GA
30106-1122
US

V. Phone/Fax

Practice location:
  • Phone: 404-265-1044
  • Fax:
Mailing address:
  • Phone: 404-265-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number054859
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: