Individual
KALYANI RAJEEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
301 MEDICAL DR, SUITE 504, LAGRANGE, GA 30240-4144
(706) 882-5437
Mailing address
301 MEDICAL DR, SUITE 504, LAGRANGE, GA 30240-4144
(706) 882-5437
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
058657
GA
208000000X
Pediatrics Physician
2002006501
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
416240451H
—
GA
Enumeration date
07/18/2005
Last updated
10/15/2019
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