Individual
DR. SUDHA R RAVOORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
110 EDGEWATER TRL, CANTON, GA 30115-1811
(770) 479-1417
(208) 275-1349
Mailing address
110 EDGEWATER TRL, CANTON, GA 30115-1811
(770) 479-1417
(208) 275-1349
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
00025176
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51002923
BLUE CROSS HOSPITAL BASED
AK
01
—
51532371
BLUE CROSS PHYSICIAN BASE
AL
Enumeration date
06/04/2006
Last updated
11/01/2007
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