Provider Demographics
NPI:1598751810
Name:PODGORSKI, GARY T (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:T
Last Name:PODGORSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1224 TROTWOOD AVE
Mailing Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, PLL
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4802
Mailing Address - Country:US
Mailing Address - Phone:931-647-5034
Mailing Address - Fax:931-552-6663
Practice Address - Street 1:1224 TROTWOOD AVE
Practice Address - Street 2:SOUTHERN RADIOLOGY ASSOCIATES, PLL
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4802
Practice Address - Country:US
Practice Address - Phone:931-647-5034
Practice Address - Fax:931-552-6663
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2021-08-12
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Provider Licenses
StateLicense IDTaxonomies
TNMD153862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN87131OtherBLUE CROSS PROVIDER NUMBE
TN3050164Medicaid
TN3050164Medicare PIN
TN3050164Medicaid