Provider Demographics
NPI:1568079143
Name:GHARTI, BIMALA
Entity Type:Individual
Prefix:DR
First Name:BIMALA
Middle Name:
Last Name:GHARTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7310 VILLAGE CREEK TRCE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6763
Mailing Address - Country:US
Mailing Address - Phone:678-488-4097
Mailing Address - Fax:
Practice Address - Street 1:7310 VILLAGE CREEK TRCE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-6763
Practice Address - Country:US
Practice Address - Phone:678-488-4097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-28
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN114351223G0001X
SC97221223G0001X
GADN1229791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice