Healthcare Provider Details

I. General information

NPI: 1972762318
Provider Name (Legal Business Name): VIKRAM BHATIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 CANTON RD
MARIETTA GA
30066-2739
US

IV. Provider business mailing address

2502 N ROCKY POINT DR SUITE- 1000
TAMPA FL
33607-1421
US

V. Phone/Fax

Practice location:
  • Phone: 770-591-3832
  • Fax:
Mailing address:
  • Phone: 813-288-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN13706
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: