Provider Demographics
NPI:1659639789
Name:GEORGIA HEALTH SCIENCES UNIVERSITY
Entity Type:Organization
Organization Name:GEORGIA HEALTH SCIENCES UNIVERSITY
Other - Org Name:MEDICAL COLLEGE OF GEORGIA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:RESIDENT-PATHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:GITIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:4141-736-5919
Mailing Address - Street 1:282 STONINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1806
Mailing Address - Country:US
Mailing Address - Phone:414-736-5919
Mailing Address - Fax:
Practice Address - Street 1:282 STONINGTON DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1806
Practice Address - Country:US
Practice Address - Phone:414-736-5919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital