Provider Demographics
NPI:1174575336
Name:PARALITICCI, RAUL E (MD)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:E
Last Name:PARALITICCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 SONG BIRD WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3780
Mailing Address - Country:US
Mailing Address - Phone:404-509-2768
Mailing Address - Fax:254-245-9284
Practice Address - Street 1:706 SONG BIRD WAY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3780
Practice Address - Country:US
Practice Address - Phone:404-509-2768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0354962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000503302Medicaid
GA000503302Medicaid
E92819Medicare UPIN