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General NPI Number Information
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NPI Number | 1548465198
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Entity Type | Individual
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Provider Name | DINESH VENKOBA RAJU MD, PHD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 01/14/2023
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Provider Practice Location Address
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Address Line | 475 PHILIP BLVD STE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8737
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Country | US
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Telephone | 678-226-6201
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Fax | 678-225-4037
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Provider Business Mailing Address
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Address Line | 10600 MEDLOCK BRIDGE RD
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City | DULUTH
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State | GA
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Zip | 30097-8404
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Country | US
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Telephone |
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Fax |
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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 | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number | 065880
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 065880
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License Number State | GA
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