Provider Demographics
NPI:1891041125
Name:AGARWAL, POOJA (MD)
Entity Type:Individual
Prefix:
First Name:POOJA
Middle Name:
Last Name:AGARWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY STE C200
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3742
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE 270
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-442-1911
Practice Address - Fax:770-442-0306
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA73097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL175378Medicaid
AL102I088156OtherMEDICARE
ALQMP000004309418OtherHEALTH SPRINGS
AL511-65349OtherBCBS
ALZ29293OtherVIVA