Individual
DR. VANCE ANDRE' RAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
335 ROSELANE ST NW STE 203, MARIETTA, GA 30060-7902
(678) 882-0878
(678) 224-8183
Mailing address
335 ROSELANE ST NW STE 203, MARIETTA, GA 30060-7902
(678) 882-0878
(678) 224-8183
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01045645A
IN
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
01045645A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200111860A
—
IN
Enumeration date
02/08/2006
Last updated
04/14/2017
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