Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 077898 | GA |
NPI | 1023307626 |
---|---|
Provider Name | Steven Peter Rayappa |
First Address | Stockbridge, GA 30281-7237 |
Second Address | Stockbridge, GA 30281-7237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2011 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
63125 | ID NUMBER (01) |