Provider Demographics
NPI:1861461816
Name:BRAR, PRABHDEEP (MD)
Entity Type:Individual
Prefix:
First Name:PRABHDEEP
Middle Name:
Last Name:BRAR
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 1:530 NORTH COBB STREET
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-2635
Mailing Address - Country:US
Mailing Address - Phone:478-453-1020
Mailing Address - Fax:478-453-1093
Practice Address - Street 1:530 NORTH COBB STREET
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2635
Practice Address - Country:US
Practice Address - Phone:478-453-1020
Practice Address - Fax:478-453-1093
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049161208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00884276AMedicaid