Provider Demographics
NPI:1164517967
Name:BHAT, SUBRAHMANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBRAHMANYA
Middle Name:
Last Name:BHAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N PARK TRL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7373
Mailing Address - Country:US
Mailing Address - Phone:770-389-1703
Mailing Address - Fax:770-389-9109
Practice Address - Street 1:145 N PARK TRL
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7373
Practice Address - Country:US
Practice Address - Phone:770-389-1703
Practice Address - Fax:770-389-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30576207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA76802OtherCIGNA
GA0402771OtherUNITED HEALTHCARE
GA00409549EMedicaid
GA4460389OtherAETNA
GA582368657001OtherCIGNA
GA983300OtherBC/BS OF GA
GA76802OtherCIGNA
GAE 27623Medicare UPIN