1164517967 NPI number — DR. SUBRAHMANYA BHAT MD

Table of content: DR. SUBRAHMANYA BHAT MD (NPI 1164517967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164517967 NPI number — DR. SUBRAHMANYA BHAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHAT
Provider First Name:
SUBRAHMANYA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1164517967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 N PARK TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOCKBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30281-7373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-389-1703
Provider Business Mailing Address Fax Number:
770-389-9109

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 N PARK TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOCKBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30281-7373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-389-1703
Provider Business Practice Location Address Fax Number:
770-389-9109
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  30576 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 76802 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0402771 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00409549E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4460389 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 582368657001 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 983300 . This is a "BC/BS OF GA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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