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NPI Code Detail

MEDICARE: DR. GARY T. PODGORSKI MD

MEDICARE: DR. GARY T. PODGORSKI 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
12085R0202XDiagnostic Radiology Physician92212SC
22085R0202XDiagnostic Radiology Physician0101286471VA
32085R0202XDiagnostic Radiology PhysicianMD15386TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
187131OTHERTNBLUE CROSS PROVIDER NUMBE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598751810
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GARY T. PODGORSKI MD
Provider Business Mailing Address
First Line : 1224 TROTWOOD AVE
Second Line : SOUTHERN RADIOLOGY ASSOCIATES, PLL
City : COLUMBIA
State : TN
Zip : 38401-4802
Country : US
Telephone Number : 931-647-5034
Fax Number : 931-552-6663
Provider Business Practice Location Address
First Line : 1224 TROTWOOD AVE
Second Line : SOUTHERN RADIOLOGY ASSOCIATES, PLL
City : COLUMBIA
State : TN
Zip : 38401-4802
Country : US
Telephone Number : 931-647-5034
Fax Number : 931-552-6663
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 02/19/2026

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