Individual
DR. NIKOLAY BANGIYEV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 FAIRVIEW PARK DR, DUBLIN, GA 31021-2547
(478) 296-7677
Mailing address
PO BOX 16550, DUBLIN, GA 31040-6550
(478) 296-7677
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
049998
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00916253A
—
GA
01
—
140466XX
PHCS,PREFERRED CARE
GA
01
—
52864485
BLUE CROSS BLUE SHIELD
GA
Enumeration date
07/01/2005
Last updated
07/08/2007
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