Basic Information
| Provider Information | |||||||||
| NPI: | 1942275433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANIKAPALLY | ||||||||
| FirstName: | ROJA | ||||||||
| MiddleName: | RAMANI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DURGAM | ||||||||
| OtherFirstName: | ROJA | ||||||||
| OtherMiddleName: | RAMANI | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2727 PACES FERRY RD SE STE 1-1100 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303396151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064755076 | ||||||||
| FaxNumber: | 7064756676 | ||||||||
| Practice Location | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064755076 | ||||||||
| FaxNumber: | 7064756676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 06/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 055742 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 055742 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 340838 | 01 | GA | WELLCARE | OTHER | 52703642-002 | 01 | GA | BCBS | OTHER | 10045166 | 01 | GA | AMERIGROUP | OTHER | 7895146 | 01 | GA | CIGNA | OTHER | P00241606 | 01 | GA | RR MEDICARE-GRP # CC4177 | OTHER | 792293772A | 05 | GA | MEDICAID | 8940079 | 01 | GA | UNITED HEALTHCARE | OTHER |