Provider Demographics
NPI:1245594985
Name:GARGODHI, GALAL Y (MD)
Entity Type:Individual
Prefix:
First Name:GALAL
Middle Name:Y
Last Name:GARGODHI
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 1:3840 PEACHTREE INDUSTRIAL BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5031
Mailing Address - Country:US
Mailing Address - Phone:404-884-5333
Mailing Address - Fax:
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BLVD STE 225
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5031
Practice Address - Country:US
Practice Address - Phone:678-730-9202
Practice Address - Fax:885-592-2998
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28612207L00000X, 208VP0000X
MA266119207L00000X, 207LP2900X
OH35.140606207L00000X, 208VP0000X
GA90833207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110122016AMedicaid