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General NPI Number Information
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NPI Number | 1447412184
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Entity Type | Individual
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Provider Name | DEEPA SANJAY JAGDALE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 699 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-9064
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Country | US
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Telephone | 706-901-7337
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Fax | 706-903-5002
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Provider Business Mailing Address
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Address Line | CSRA PEDS 699 FURYS FERRY RD
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City | MARTINEZ
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State | GA
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Zip | 30907-3093
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Country | US
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Telephone | 706-901-7337
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Fax | 706-903-5002
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 31458
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 003071
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License Number State | GA
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