Provider Demographics
NPI:1285749143
Name:GARG, CHANDRIKA (MD)
Entity type:Individual
Prefix:MRS
First Name:CHANDRIKA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 QUARTZ DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-3255
Mailing Address - Country:US
Mailing Address - Phone:770-949-7500
Mailing Address - Fax:770-942-8800
Practice Address - Street 1:101 QUARTZ DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-3255
Practice Address - Country:US
Practice Address - Phone:770-949-7500
Practice Address - Fax:770-942-8800
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA054376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I21691Medicare UPIN