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General NPI Number Information
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NPI Number | 1881911915
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Entity Type | Individual
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Provider Name | GAUTAM BHATIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 890 W FARIS RD STE 550
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City | GREENVILLE
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State | SC
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Zip | 29605-4286
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Country | US
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Telephone | 864-455-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8611
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | LL32614
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 32614
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License Number State | SC
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