Healthcare Provider Details

I. General information

NPI: 1124671649
Provider Name (Legal Business Name): PRIYA VARGHESE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 SPARTA WAY
BUFORD GA
30519-2001
US

IV. Provider business mailing address

2334 SPARTA WAY
BUFORD GA
30519-2001
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-8109
  • Fax:
Mailing address:
  • Phone: 770-536-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT218754
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number112681
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: