Individual
DR. DEEPA SANJAY JAGDALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
699 FURYS FERRY RD, MARTINEZ, GA 30907-9064
(706) 901-7337
(706) 903-5002
Mailing address
CSRA PEDS, 699 FURYS FERRY RD, MARTINEZ, GA 30907-3093
(706) 901-7337
(706) 903-5002
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
003071
GA
208000000X
Pediatrics Physician
31458
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003161963F
—
GA
05
—
314582
—
SC
Enumeration date
06/25/2008
Last updated
03/07/2024
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