Healthcare Provider Details

I. General information

NPI: 1285749143
Provider Name (Legal Business Name): CHANDRIKA GARG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 QUARTZ DR SUITE 101
VILLA RICA GA
30180-3255
US

IV. Provider business mailing address

101 QUARTZ DR SUITE 101
VILLA RICA GA
30180-3255
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-7500
  • Fax: 770-942-8800
Mailing address:
  • Phone: 770-949-7500
  • Fax: 770-942-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number054376
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: