MEDICARE: DR. THOMAS RAMDHANIE LALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	70138	GA
2	207R00000X	Internal Medicine Physician	4301088005	MI
3	207R00000X	Internal Medicine Physician	070138	GA

General Provider Information

NPI Number	:	1073731428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS RAMDHANIE LALL M.D.

Provider Business Mailing Address
First Line	:	3144 TOWERVIEW DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-2539
Country	:	US
Telephone Number	:	313-575-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 BOULEVARD NE STE 525
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-4211
Country	:	US
Telephone Number	:	404-265-1044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	01/07/2023

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