Healthcare Provider Details

I. General information

NPI: 1679749287
Provider Name (Legal Business Name): GAURI R KHORJEKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2008
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ACADEMY ST NW
GAINESVILLE GA
30501-8568
US

IV. Provider business mailing address

22 S GREENE ST, DEPT OF RADIOLOGY
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 770-282-8820
  • Fax:
Mailing address:
  • Phone: 410-328-3477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD041317
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0076567
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number91139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: