=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629371497
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VISITING PHYSICIAN CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2010
-----------------------------------------------------
Last Update Date | 07/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5675 JIMMY CARTER BLVD SUITE #K
-----------------------------------------------------
City | NORCROSS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30071-2965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-744-7688
-----------------------------------------------------
Fax | 770-406-1058
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 230 WYTHEFORD CT
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30004-5082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-218-3468
-----------------------------------------------------
Fax | 770-406-1058
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | DR. VENKATAPPA RANGARAJ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 513-218-3468
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | 058633
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------