Basic Information
| Provider Information | |||||||||
| NPI: | 1477733053 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHARTI | ||||||||
| FirstName: | GAURAV | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 N STATE OF FRANKLIN RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
| FaxNumber: | 4234397219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2007 | ||||||||
| LastUpdateDate: | 06/11/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | MD48445 | TN | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.