Active NPI
Sundari Raju, MD
- Family Medicine Physician
- Lumpkin, GA
National Provider Identifier
1760470892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 040199
- Practice address
- 126 East Broad Street
Lumpkin, GA 31815 - Phone
- (229) 838-0885
- Fax
- (229) 838-0887
- NPI assigned
- Oct 12, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 040199 | GA | Primary |
Addresses
Primary practice location
126 East Broad Street
Lumpkin, GA 31815
Mailing address
PO Box 158
126 East Broad Street
Lumpkin, GA 31815
Phone (229) 838-0885
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1625183 | Other | FIRST HEALTH | |
| P00174258 | Other | RAILROAD MEDICARE | |
| 000680699F | Medicaid | GA | |
| 1379773 | Other | CIGNA | |
| 0101742 | Other | UNITED HEALTHCARE | |
| 52596864001 | Other | BCBS GA | |
| 450491390RAJ1 | Other | EVERGREEN | |
| 60027561 | Other | BCBS AL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040199 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1760470892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 158",
"address_2": "126 EAST BROAD STREET",
"city": "LUMPKIN",
"state": "GA",
"postal_code": "31815",
"telephone_number": "229-838-0885",
"fax_number": "229-838-0887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "126 EAST BROAD STREET",
"city": "LUMPKIN",
"state": "GA",
"postal_code": "31815",
"telephone_number": "229-838-0885",
"fax_number": "229-838-0887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAJU",
"first_name": "SUNDARI",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-12",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "040199",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1625183",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00174258",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000680699F",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "1379773",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "0101742",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GA",
"identifier": "52596864001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EVERGREEN",
"identifier": "450491390RAJ1",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS AL",
"identifier": "60027561",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Lumpkin, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.