| Middle Georgia Internal Medicine Llc | |
|
2400 Bellevue Rd Suite 19-b Erin Office Park Dublin GA 31021-2885 | |
| (478) 272-2599 | |
| (478) 272-6441 |
| Full Name | Middle Georgia Internal Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2400 Bellevue Rd, Dublin, Georgia |
| Authorized Official Name and Position | Raghu Nandan Lolabhattu (PROVIDER) |
| Authorized Official Contact | 4782722599 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Middle Georgia Internal Medicine Llc Po Box 845 Suite 19-b Erin Office Park Dublin GA 31040-0845 Ph: (478) 272-2599 | Middle Georgia Internal Medicine Llc 2400 Bellevue Rd Suite 19-b Erin Office Park Dublin GA 31021-2885 Ph: (478) 272-2599 |
| NPI Number | 1306968235 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4880842079 |
|---|---|
| Medicare Enrollment ID | O20120912000893 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306968235 | NPI | - | NPPES |
| 00901183C | Medicaid | GA | |
| 1851397368 | Other | GA | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Raghu N Lolabhattu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851397368 PECOS PAC ID: 2567352941 Enrollment ID: I20040318000950 |
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