Organization
BLACKPOOL LLC
Active
Other names
Georgia Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VENKATAPPA RANGARAJ MD (OWNER)
(513) 218-3468
Entity
Organization
Contact information
Practice address
4415 FRONT NINE DR STE 600, CUMMING, GA 30041-6239
(770) 744-7688
(770) 406-1058
Mailing address
4415 FRONT NINE DR STE 600, CUMMING, GA 30041-6239
(770) 744-7688
(770) 406-1058
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
058633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003132617A
—
GA
Enumeration date
04/01/2013
Last updated
02/14/2023
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