Provider Demographics
NPI:1154397065
Name:GACHA, MARIA FERNANDA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:FERNANDA
Last Name:GACHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-8777
Practice Address - Fax:864-560-6013
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025602207R00000X
SC33230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51533736OtherBCBS ALABAMA
SCSCA510H888OtherMEDICARE PIN
NC5919489Medicaid
AL009936874Medicaid
SCSCH3705019OtherMEDICARE PIN
SC332303Medicaid
SCAA71585096Medicaid
ALI01720Medicare UPIN
SCAA71585096Medicaid