Provider Demographics
NPI:1184617599
Name:SIDHPURA, JAGDISH R (MD)
Entity type:Individual
Prefix:
First Name:JAGDISH
Middle Name:R
Last Name:SIDHPURA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 CENTER ST
Mailing Address - Street 2:STE 304
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1546
Mailing Address - Country:US
Mailing Address - Phone:706-322-0176
Mailing Address - Fax:706-322-0337
Practice Address - Street 1:700 CENTER ST
Practice Address - Street 2:STE 304
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1546
Practice Address - Country:US
Practice Address - Phone:706-322-0176
Practice Address - Fax:706-322-0337
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0267522084N0400X
AL000130672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C74523Medicare UPIN