1952433864 NPI number — SUVRAT J BHARGAVE MD PC

Table of content: (NPI 1952433864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952433864 NPI number — SUVRAT J BHARGAVE MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUVRAT J BHARGAVE MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952433864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 LORING LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEACHTREE CITY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30269-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-486-1011
Provider Business Mailing Address Fax Number:
770-486-1067

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 HANDLEY RD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
TYRONE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30290-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-486-1011
Provider Business Practice Location Address Fax Number:
770-486-1067
Provider Enumeration Date:
03/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BHARGAVE
Authorized Official First Name:
SUVRAT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
770-486-1011

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  047297 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 002261 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)