Healthcare Provider Details

I. General information

NPI: 1942598958
Provider Name (Legal Business Name): RAMAN BABAYEUSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 02/20/2023
Certification Date: 02/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 301
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

619 S 8TH ST STE 301
GRIFFIN GA
30224-4260
US

V. Phone/Fax

Practice location:
  • Phone: 770-229-6072
  • Fax: 770-229-2111
Mailing address:
  • Phone: 770-229-6072
  • Fax: 770-229-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2017011852
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS6569
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number93722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: