Healthcare Provider Details

I. General information

NPI: 1912174095
Provider Name (Legal Business Name): SAGAR GARUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD STE 2000
CUMMING GA
30041-6205
US

IV. Provider business mailing address

1001 SUMMIT BLVD STE 200
BROOKHAVEN GA
30319-6410
US

V. Phone/Fax

Practice location:
  • Phone: 770-781-4010
  • Fax: 770-781-5334
Mailing address:
  • Phone: 770-989-1634
  • Fax: 678-358-1759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number070384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: