Individual
DEEPAK BHAGWANDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT,MD
Contact information
Practice address
7529 SHANNON OAK DR, RIVERDALE, GA 30296-1445
(770) 909-1057
(770) 909-1057
Mailing address
7529,SHANNON OAK DR, RIVERDALE, GA 30296-1445
(770) 909-1057
(770) 909-1057
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25720
FL
225100000X
Physical Therapist
Primary
PT004124
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT004124
STATE LISC NUMBER
GA
Enumeration date
11/07/2006
Last updated
03/06/2018
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