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General NPI Number Information
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NPI Number | 1306968235
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Entity Type | Organization
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Legal Business Name | MIDDLE GEORGIA INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2400 BELLEVUE RD SUITE 19-B ERIN OFFICE PARK
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City | DUBLIN
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State | GA
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Zip | 31021-2885
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Country | US
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Telephone | 478-272-2599
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Fax | 478-272-6441
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Provider Business Mailing Address
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Address Line | PO BOX 845 SUITE 19-B ERIN OFFICE PARK
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City | DUBLIN
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State | GA
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Zip | 31040-0845
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Country | US
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Telephone | 478-272-2599
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Fax | 478-272-6441
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. RAGHU NANDAN LOLABHATTU
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Credential | M.D.
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Telephone | 478-272-2599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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