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General NPI Number Information
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NPI Number | 1194820274
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Entity Type | Individual
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Provider Name | RAPHAEL G LOUTOBY MD
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 870 NORTHSIDE DR NW
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City | ATLANTA
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State | GA
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Zip | 30318-5763
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Country | US
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Telephone | 404-733-1170
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Fax | 404-733-1172
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Provider Business Mailing Address
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Address Line | PO BOX 52725
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City | ATLANTA
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State | GA
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Zip | 30355-0725
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Country | US
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Telephone | 404-733-1170
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Fax | 404-733-1172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 039853
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License Number State | GA
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