Healthcare Provider Details

I. General information

NPI: 1477733491
Provider Name (Legal Business Name): RAKESH KUMAR MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2007
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SPARTA HWY
EATONTON GA
31024-6093
US

IV. Provider business mailing address

PO BOX 4150
EATONTON GA
31024-4150
US

V. Phone/Fax

Practice location:
  • Phone: 707-485-2621
  • Fax:
Mailing address:
  • Phone: 706-485-2621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number022807
License Number StateGA

VIII. Authorized Official

Name: DR. RAKESH KUMAR
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 707-485-2621