Provider Demographics
NPI:1245214667
Name:BHARADWAJ, NIRMALA (MD)
Entity Type:Individual
Prefix:
First Name:NIRMALA
Middle Name:
Last Name:BHARADWAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIRMALA
Other - Middle Name:
Other - Last Name:SESHADRI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30515-0699
Mailing Address - Country:US
Mailing Address - Phone:678-804-9398
Mailing Address - Fax:678-804-9415
Practice Address - Street 1:3700 RIDGE RD
Practice Address - Street 2:SUITE'B'
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4035
Practice Address - Country:US
Practice Address - Phone:678-804-9398
Practice Address - Fax:678-804-9415
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044838208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000818375GMedicaid
GAG98421Medicare UPIN
GA37BBGPVMedicare ID - Type Unspecified