Provider Demographics
NPI:1205872116
Name:JAGLAN, SANDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:JAGLAN
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 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 460
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-427-7389
Mailing Address - Fax:770-427-2845
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 460
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-427-7389
Practice Address - Fax:770-427-2845
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057561174400000X
GAGA057561207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA955029596AAMedicaid
GA955029596OMedicaid
GA057561OtherSTATE LICENSE
GA955029596FMedicaid
GA955029596WMedicaid
GA955029596MMedicaid
GA955029596QMedicaid
GA955029596LMedicaid
GA955029596SMedicaid
GA955029596AMedicaid
GA955029596BMedicaid
GA955029596CMedicaid
GA955029596IMedicaid
GA955029596NMedicaid
GA955029596RMedicaid
GA955029596TMedicaid
GA955029596UMedicaid
GA955029596XMedicaid
GA955029596YMedicaid
GA955029596PMedicaid
GA955029596VMedicaid