Provider Demographics
NPI:1720014871
Name:DESHPANDE, PRIYA SUDHAKAR (MD)
Entity Type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:SUDHAKAR
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8274
Mailing Address - Fax:706-650-9540
Practice Address - Street 1:3614D J DEWEY GRAY CIR STE D
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1806
Practice Address - Country:US
Practice Address - Phone:706-868-7380
Practice Address - Fax:706-868-7223
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049002207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA336957OtherWELLCARE
GACH0654OtherRR MEDICARE GROUP PIN
SCG49002Medicaid
GA049002OtherLICENSE
GA0875916AMedicaid
GA10056076OtherAMERIGROUP
GABD4434736OtherDEA