Healthcare Provider Details

I. General information

NPI: 1174518856
Provider Name (Legal Business Name): RAM K PURI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 COLUMBIA DR
MILLEDGEVILLE GA
31061-2395
US

IV. Provider business mailing address

1209 COLUMBIA DR
MILLEDGEVILLE GA
31061-2395
US

V. Phone/Fax

Practice location:
  • Phone: 478-452-3200
  • Fax: 478-452-1515
Mailing address:
  • Phone: 478-452-3200
  • Fax: 478-452-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number021573
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number021573
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021573
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: