Healthcare Provider Details

I. General information

NPI: 1104812437
Provider Name (Legal Business Name): RAJEEV CHAUHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/16/2022
Certification Date: 12/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6228 BRADLEY PARK DR SUITE A
COLUMBUS GA
31904-3603
US

IV. Provider business mailing address

6228 BRADLEY PARK DR SUITE A
COLUMBUS GA
31904-3603
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-1486
  • Fax: 706-324-3419
Mailing address:
  • Phone: 706-322-1486
  • Fax: 706-324-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number53587
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25539
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: