Healthcare Provider Details

I. General information

NPI: 1174500128
Provider Name (Legal Business Name): SHARAD ANANT GHAMANDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST GEORGIA REGENTS MEDICAL ASSOCIATES
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

1120 15TH ST GEORGIA REGENTS MEDICAL ASSOCIATES
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-3993
  • Fax: 706-721-9777
Mailing address:
  • Phone: 706-721-3992
  • Fax: 706-721-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number049173
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number207VX0201X
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: