Individual
DR. JAY R PRAKASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6555 PROFESSIONAL PL, SUITE C, RIVERDALE, GA 30274-2519
(770) 996-5959
(770) 991-1596
Mailing address
6555 PROFESSIONAL PL, SUITE C, RIVERDALE, GA 30274-2519
(770) 996-5959
(770) 991-1596
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
025986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00292322A
—
GA
Enumeration date
07/03/2006
Last updated
07/08/2007
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