Individual
DOLLY S RAJAMANNAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
158 FAIRVIEW RD STE B, ELLENWOOD, GA 30294-2795
(678) 289-5835
(678) 289-5837
Mailing address
158 FAIRVIEW RD STE B, ELLENWOOD, GA 30294-2795
(678) 289-5835
(678) 289-5837
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT001823
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00879018A
—
GA
05
—
00879018B
—
GA
Enumeration date
09/20/2006
Last updated
07/09/2007
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