Provider Demographics
NPI:1992743140
Name:BORKAT, GORDON (MD)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:BORKAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2835 BRANDYWINE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-5510
Mailing Address - Country:US
Mailing Address - Phone:770-488-9202
Mailing Address - Fax:678-547-1494
Practice Address - Street 1:705 17TH ST
Practice Address - Street 2:STE 406
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3500
Practice Address - Country:US
Practice Address - Phone:770-488-9212
Practice Address - Fax:678-547-1494
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0309592080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00594613AMedicaid
06BDCTLMedicare ID - Type Unspecified
GA00594613AMedicaid