Basic Information
| Provider Information | |||||||||
| NPI: | 1194781070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAZIANO | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5730 GLENRIDGE DR NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303286141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048163000 | ||||||||
| FaxNumber: | 6789045797 | ||||||||
| Practice Location | |||||||||
| Address1: | 5730 GLENRIDGE DR NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303286141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048163000 | ||||||||
| FaxNumber: | 6789045797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 09/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 050988 | GA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1710946322 | 01 | GA | GROUP NPI NUMBER | OTHER | 646007054A | 05 | GA | MEDICAID | 7627358 | 01 | GA | CIGNA | OTHER |