Provider Demographics
NPI:1326270356
Name:SANGWAN, VIKAS KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:KUMAR
Last Name:SANGWAN
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 1:3320 OLD JEFFERSON RD BLDG 800
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-353-2990
Mailing Address - Fax:706-353-2992
Practice Address - Street 1:658 N CHASE ST STE 201
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1960
Practice Address - Country:US
Practice Address - Phone:762-356-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-09
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96331207RG0100X
PAMD446110208M00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist