Provider Demographics
NPI:1689718215
Name:TONGIA, SHRADDHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHRADDHA
Middle Name:
Last Name:TONGIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHRADDHA
Other - Middle Name:
Other - Last Name:UPADHYAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:BUILDING 200, SUITE A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-549-5560
Mailing Address - Fax:706-543-2593
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BUILDING 200, SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-549-5560
Practice Address - Fax:706-543-2593
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56374207RP1001X, 207RC0200X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA589958479AMedicaid
GA29BDCNLMedicare ID - Type Unspecified
GA589958479AMedicaid