Provider Demographics
NPI:1447329263
Name:BHAGWANDAS, DEEPAK (PT,MD)
Entity type:Individual
Prefix:
First Name:DEEPAK
Middle Name:
Last Name:BHAGWANDAS
Suffix:
Gender:M
Credentials:PT,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7529,SHANNON OAK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1445
Mailing Address - Country:US
Mailing Address - Phone:770-909-1057
Mailing Address - Fax:770-909-1057
Practice Address - Street 1:7529 SHANNON OAK DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1445
Practice Address - Country:US
Practice Address - Phone:770-909-1057
Practice Address - Fax:770-909-1057
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25720207R00000X
GAPT004124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT004124OtherSTATE LISC NUMBER