MEDICARE: JAGDISH R SIDHPURA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	026752	GA
2	2084N0400X	Neurology Physician	00013067	AL

General Provider Information

NPI Number	:	1184617599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAGDISH R SIDHPURA MD

Provider Business Mailing Address
First Line	:	700 CENTER ST
Second Line	:	STE 304
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1546
Country	:	US
Telephone Number	:	706-322-0176
Fax Number	:	706-322-0337

Provider Business Practice Location Address
First Line	:	700 CENTER ST
Second Line	:	STE 304
City	:	COLUMBUS
State	:	GA
Zip	:	31901-1546
Country	:	US
Telephone Number	:	706-322-0176
Fax Number	:	706-322-0337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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