Provider Demographics
NPI:1912174095
Name:GARUD, SAGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAGAR
Middle Name:
Last Name:GARUD
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 1:1001 SUMMIT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-6410
Mailing Address - Country:US
Mailing Address - Phone:770-989-1634
Mailing Address - Fax:678-358-1759
Practice Address - Street 1:1505 NORTHSIDE BLVD STE 2000
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6205
Practice Address - Country:US
Practice Address - Phone:770-781-4010
Practice Address - Fax:770-781-5334
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070384207RG0100X
MA228158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003136893CMedicaid