Provider Demographics
NPI:1467143313
Name:CSRA HEALTH LLC
Entity Type:Organization
Organization Name:CSRA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-399-2825
Mailing Address - Street 1:629 HIGH HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9126
Mailing Address - Country:US
Mailing Address - Phone:706-399-2825
Mailing Address - Fax:
Practice Address - Street 1:699 FURYS FERRY ROAD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-399-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty