Provider Demographics
NPI:1720015027
Name:GHARGE, JYOTI (MD)
Entity Type:Individual
Prefix:MRS
First Name:JYOTI
Middle Name:
Last Name:GHARGE
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 1:1909 ABERDEEN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701
Mailing Address - Country:US
Mailing Address - Phone:229-430-7256
Mailing Address - Fax:229-430-7258
Practice Address - Street 1:1909 ABERDEEN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-430-7256
Practice Address - Fax:229-430-7258
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055750208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA430070034AMedicaid
GA52187050002OtherBCBS
GA430070034AMedicaid
GA25BBFXFMedicare PIN
GA52187050002OtherBCBS