Provider Demographics
NPI:1013099001
Name:DEVKOTA, JAGADISHWAR (MD)
Entity Type:Individual
Prefix:
First Name:JAGADISHWAR
Middle Name:
Last Name:DEVKOTA
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 1:20 WINGED FOOT DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9140
Mailing Address - Country:US
Mailing Address - Phone:706-414-8235
Mailing Address - Fax:706-364-2606
Practice Address - Street 1:20 WINGED FOOT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-9140
Practice Address - Country:US
Practice Address - Phone:706-414-8235
Practice Address - Fax:706-364-2606
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0176022085B0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00185138DMedicaid
GAD45216Medicare UPIN
GA00185138DMedicaid