Provider Demographics
NPI:1760560726
Name:GHOSH, TARUN KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:TARUN
Middle Name:KUMAR
Last Name:GHOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 HEMLOCK ST
Mailing Address - Street 2:220
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8329
Mailing Address - Country:US
Mailing Address - Phone:478-741-7241
Mailing Address - Fax:478-745-8932
Practice Address - Street 1:535 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-0104
Practice Address - Country:US
Practice Address - Phone:478-803-7300
Practice Address - Fax:478-803-7532
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00872176AMedicaid
GA11BDRTKMedicare ID - Type UnspecifiedMEDICARE PROVIDER #