Healthcare Provider Details

I. General information

NPI: 1760557284
Provider Name (Legal Business Name): PULIPAKA B RAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 MORNINGSIDE DR
PERRY GA
31069-2905
US

IV. Provider business mailing address

1117 MORNINGSIDE DR
PERRY GA
31069-2905
US

V. Phone/Fax

Practice location:
  • Phone: 478-224-1976
  • Fax: 478-224-1646
Mailing address:
  • Phone: 478-224-1976
  • Fax: 478-224-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number023210
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: