Provider Demographics
NPI:1447284138
Name:PAUL, RANJAN (MD)
Entity type:Individual
Prefix:
First Name:RANJAN
Middle Name:
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 PEACHTREE PARKWAY
Mailing Address - Street 2:SUITE D-170
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6008
Mailing Address - Country:US
Mailing Address - Phone:770-623-0008
Mailing Address - Fax:770-623-0009
Practice Address - Street 1:4355 JOHN'S CREEK PARKWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6085
Practice Address - Country:US
Practice Address - Phone:770-623-0008
Practice Address - Fax:770-623-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054087207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA801250932AMedicaid
GAGRP6956OtherMEDICARE GROUP
GAG35955Medicare UPIN
GAGRP6956OtherMEDICARE GROUP