Provider Demographics
NPI:1235130808
Name:MIKKILINENI, RAO S (MD)
Entity type:Individual
Prefix:MR
First Name:RAO
Middle Name:S
Last Name:MIKKILINENI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:483 UPPER RIVERDALE ROAD, SUITE A
Mailing Address - Street 2:RAI S. MIKKILINENI, M.D.
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2584
Mailing Address - Country:US
Mailing Address - Phone:770-991-3888
Mailing Address - Fax:770-994-0278
Practice Address - Street 1:483 UPPER RIVERDALE RD SW, SUITE A
Practice Address - Street 2:SOUTH ATLANTA PULMONARY & CRITICAL CARE ASS
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2584
Practice Address - Country:US
Practice Address - Phone:770-991-3888
Practice Address - Fax:770-994-0278
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-03-20
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Provider Licenses
StateLicense IDTaxonomies
GA023852207R00000X, 207RP1001X
GAGA023852207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00322308AMedicaid
F73335Medicare UPIN
29BDMZMedicare ID - Type Unspecified