Provider Demographics
NPI:1952433864
Name:SUVRAT J BHARGAVE MD PC
Entity Type:Organization
Organization Name:SUVRAT J BHARGAVE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUVRAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHARGAVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-486-1011
Mailing Address - Street 1:307 LORING LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4241
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0472972084P0800X
GA002261363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty