Basic Information
| Provider Information | |||||||||
| NPI: | 1215250162 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAO | ||||||||
| FirstName: | SUPRIYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 HOSPITAL SOUTH DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301068159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709417717 | ||||||||
| FaxNumber: | 7709489729 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 JOHNSON FERRY RD NE STE 900 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303424768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783760528 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2010 | ||||||||
| LastUpdateDate: | 10/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 63799 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.