Healthcare Provider Details

I. General information

NPI: 1215040829
Provider Name (Legal Business Name): VARALAKSHMI N RAO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ARLINGTON DRIVE
VIDALIA GA
30474
US

IV. Provider business mailing address

1610 N CHENEY DR
VIDALIA GA
30474-4321
US

V. Phone/Fax

Practice location:
  • Phone: 912-538-0830
  • Fax: 912-538-1333
Mailing address:
  • Phone: 912-537-9227
  • Fax: 912-538-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20007
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: