Individual
RAJU MIDHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1404 MONTREAL RD, TUCKER, GA 30084
(770) 492-8665
(770) 492-8663
Mailing address
1404 MONTREAL RD, TUCKER, GA 30084
(770) 492-8665
(770) 492-8663
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
54164
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003108944B
—
GA
01
—
054164
LICENSE
GA
Enumeration date
10/24/2005
Last updated
11/03/2020
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