Healthcare Provider Details

I. General information

NPI: 1700864873
Provider Name (Legal Business Name): RATNA SAJJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 WELLBROOK CIR NE
CONYERS GA
30012-3873
US

IV. Provider business mailing address

PO BOX 116470
ATLANTA GA
30368-6470
US

V. Phone/Fax

Practice location:
  • Phone: 770-922-2012
  • Fax: 770-922-8370
Mailing address:
  • Phone: 770-682-2099
  • Fax: 866-423-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberM2071
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number072458
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: