Healthcare Provider Details

I. General information

NPI: 1801970744
Provider Name (Legal Business Name): RAJENDRA M. VAZIRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

PO BOX 910329
SAN DIEGO CA
92191-0329
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-6000
  • Fax:
Mailing address:
  • Phone: 888-727-1070
  • Fax: 877-883-5176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA100579
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: