Individual
TONY MIHIR GHODADRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 W ACADEMY ST NW, GAINESVILLE, GA 30501-8568
(770) 282-8820
Mailing address
PO BOX 2417, GAINESVILLE, GA 30503-2417
(770) 532-9936
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
97997
GA
2085R0202X
Diagnostic Radiology Physician
MD39942
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3336402
—
TN
05
—
3336403
—
TN
05
—
3729238
—
TN
01
—
4114932
BCBS
—
01
—
4114934
BCBS
—
01
—
P00278185
RR MEDICARE
—
Enumeration date
03/02/2006
Last updated
04/03/2024
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