Provider Demographics
NPI:1720070501
Name:BHARGAVE, SUVRAT JAGANNIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SUVRAT
Middle Name:JAGANNIVAS
Last Name:BHARGAVE
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 1:120 HANDLEY RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2177
Mailing Address - Country:US
Mailing Address - Phone:770-486-1011
Mailing Address - Fax:770-486-1067
Practice Address - Street 1:120 HANDLEY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2177
Practice Address - Country:US
Practice Address - Phone:770-486-1011
Practice Address - Fax:770-486-1067
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2012-03-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
GA047297174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist