MEDICARE: HANGING DROP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	4301075665	MI
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	4301075665	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01003119	OTHER	MI	HEALTHPLUS
2	0500910751	OTHER	MI	BCR

General Provider Information

NPI Number	:	1932238987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANGING DROP PC

Provider Business Mailing Address
First Line	:	2010 15TH ST.
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708
Country	:	US
Telephone Number	:	989-894-5621
Fax Number	:	989-893-3528

Provider Business Practice Location Address
First Line	:	2010 15TH ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7606
Country	:	US
Telephone Number	:	989-894-5621
Fax Number	:	989-893-3528

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ZAZA GODZIASHVILI
Credential	:	M.D.
Telephone Number	:	989-894-5621

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/20/2015

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Directions to “HANGING DROP PC ” Practice Location

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