Provider Demographics
NPI:1144235979
Name:BHANDIWAD, ANITA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:R
Last Name:BHANDIWAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1505 NORTHSIDE BLVD STE 3600
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8245
Mailing Address - Country:US
Mailing Address - Phone:470-639-6272
Mailing Address - Fax:770-781-3559
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 3600
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8245
Practice Address - Country:US
Practice Address - Phone:470-639-6272
Practice Address - Fax:770-781-3559
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011006544207RC0000X
GA54550207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205559008Medicaid