Individual
MUKUND C RAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
475 PHILIP BLVD, SUITE 201, LAWRENCEVILLE, GA 30046-8737
(770) 962-0220
(770) 962-1566
Mailing address
475 PHILIP BLVD, SUITE 201, LAWRENCEVILLE, GA 30046-8737
(770) 962-0220
(770) 962-1566
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
026028
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00302541A
—
GA
Enumeration date
08/27/2006
Last updated
09/03/2014
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