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General NPI Number Information
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NPI Number | 1679530646
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Entity Type | Individual
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Provider Name | PALANISAMY RAJASEKARAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 700 MEDICAL CENTER BLVD GWINNETT WOMENS PAVILION
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-7693
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Country | US
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Telephone | 770-921-4492
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Fax | 770-696-3358
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Provider Business Mailing Address
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Address Line | 1180 VINTAGE CLUB DR
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City | DULUTH
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State | GA
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Zip | 30097-2008
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Country | US
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Telephone | 770-329-1216
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Fax | 770-696-4051
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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 | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 052204
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License Number State | GA
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