Individual
PUNAM BHANOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30045
(678) 442-4321
(770) 682-2242
Mailing address
1605 LAKES PARKWAY, PATHOLOGY DEPT, LAWRENCEVILLE, GA 30043
(770) 237-4500
(770) 237-4539
Taxonomy
Speciality
Code
Description
License number
State
207ZC0500X
Cytopathology Physician
056521
GA
207ZP0101X
Anatomic Pathology Physician
Primary
056521
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00064970
RAILROAD MEDICARE
GA
Enumeration date
04/19/2006
Last updated
10/30/2007
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