Healthcare Provider Details

I. General information

NPI: 1952433864
Provider Name (Legal Business Name): SUVRAT J BHARGAVE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HANDLEY RD SUITE 310
TYRONE GA
30290-2177
US

IV. Provider business mailing address

307 LORING LN
PEACHTREE CITY GA
30269-4241
US

V. Phone/Fax

Practice location:
  • Phone: 770-486-1011
  • Fax: 770-486-1067
Mailing address:
  • Phone: 770-486-1011
  • Fax: 770-486-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number047297
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002261
License Number StateGA

VIII. Authorized Official

Name: SUVRAT J BHARGAVE
Title or Position: PRESIDENT
Credential: MD
Phone: 770-486-1011