Individual
MRS. SUNDARI RAJU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
126 EAST BROAD STREET, LUMPKIN, GA 31815
(229) 838-0885
(229) 838-0887
Mailing address
PO BOX 158, 126 EAST BROAD STREET, LUMPKIN, GA 31815
(229) 838-0885
(229) 838-0887
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
040199
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000680699F
—
GA
01
—
0101742
UNITED HEALTHCARE
—
01
—
1379773
CIGNA
—
01
—
1625183
FIRST HEALTH
—
01
—
450491390RAJ1
EVERGREEN
—
01
—
52596864001
BCBS GA
—
01
—
60027561
BCBS AL
—
01
—
P00174258
RAILROAD MEDICARE
—
Enumeration date
10/12/2005
Last updated
09/22/2008
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