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General NPI Number Information
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NPI Number | 1598751810
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Entity Type | Individual
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Provider Name | GARY T. PODGORSKI MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 08/21/2024
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Provider Practice Location Address
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Address Line | 1224 TROTWOOD AVE SOUTHERN RADIOLOGY ASSOCIATES, PLL
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City | COLUMBIA
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State | TN
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Zip | 38401-4802
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Country | US
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Telephone | 931-647-5034
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Fax | 931-552-6663
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Provider Business Mailing Address
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Address Line | 1224 TROTWOOD AVE SOUTHERN RADIOLOGY ASSOCIATES, PLL
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City | COLUMBIA
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State | TN
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Zip | 38401-4802
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Country | US
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Telephone | 931-647-5034
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Fax | 931-552-6663
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 92212
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD15386
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License Number State | TN
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