Provider Demographics
NPI:1902806508
Name:IYER, RAVI S (MD)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3579 HIGHWAY 138
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4142
Mailing Address - Country:US
Mailing Address - Phone:678-565-3300
Mailing Address - Fax:678-565-3311
Practice Address - Street 1:3579 HIGHWAY 138
Practice Address - Street 2:SUITE 103
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-4142
Practice Address - Country:US
Practice Address - Phone:678-565-3300
Practice Address - Fax:678-565-3311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042292208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
31222929007OtherCIGNA
GA52012797-02OtherBCBS
GA52012797-02OtherBCBS
G44514Medicare UPIN