Provider Demographics
NPI:1871053314
Name:NAGARAJA, KISHORE GHATGE (MD)
Entity type:Individual
Prefix:DR
First Name:KISHORE
Middle Name:GHATGE
Last Name:NAGARAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:
Practice Address - Street 1:1337 E GARRISON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5127
Practice Address - Country:US
Practice Address - Phone:704-865-3848
Practice Address - Fax:704-854-3086
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-007222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry