Provider Demographics
NPI:1033111349
Name:RAMANI, POONAM (MD)
Entity type:Individual
Prefix:
First Name:POONAM
Middle Name:
Last Name:RAMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:134 BAYBERRY HLS
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4005
Mailing Address - Country:US
Mailing Address - Phone:678-571-3113
Mailing Address - Fax:770-507-8383
Practice Address - Street 1:105 CARNEGIE PL STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-5900
Practice Address - Country:US
Practice Address - Phone:770-716-7999
Practice Address - Fax:770-716-8444
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2024-05-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA052319207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH80128Medicare UPIN