Individual
TOSAPORN KRASAEATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1703 MEADOWS LN, VIDALIA, GA 30474-8915
(800) 382-4023
Mailing address
PO BOX 2049, MOULTRIE, GA 31776-2049
(800) 382-4023
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
026884
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000292289C
—
GA
Enumeration date
11/14/2005
Last updated
07/08/2007
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