1902806508 NPI number — DR. RAVI S IYER MD

Table of content: DR. RAVI S IYER MD (NPI 1902806508)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902806508 NPI number — DR. RAVI S IYER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IYER
Provider First Name:
RAVI
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902806508
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3579 HIGHWAY 138
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-4142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-565-3300
Provider Business Mailing Address Fax Number:
678-565-3311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3579 HIGHWAY 138
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-4142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-565-3300
Provider Business Practice Location Address Fax Number:
678-565-3311
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  042292 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2080N0001X , with the licence number: 042292 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31222929007 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52012797-02 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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