MEDICARE: DR. RAKESH KUMAR MD

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	207Q00000X	Family Medicine Physician	22807	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	020000895	OTHER	GA	MCARE RAILROAD
3	017280	OTHER	GA	BCBS OF GA

General Provider Information

NPI Number	:	1205828696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAKESH KUMAR MD

Provider Business Mailing Address
First Line	:	PO BOX 4150
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-4150
Country	:	US
Telephone Number	:	706-485-2621
Fax Number	:	706-485-9354

Provider Business Practice Location Address
First Line	:	123 SPARTA HWY
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-6093
Country	:	US
Telephone Number	:	706-485-2621
Fax Number	:	706-485-9354

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	10/29/2007

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