Basic Information
| Provider Information | |||||||||
| NPI: | 1912174095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARUD | ||||||||
| FirstName: | SAGAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 SUMMIT BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | BROOKHAVEN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303196410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709891634 | ||||||||
| FaxNumber: | 6783581759 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300416205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707814010 | ||||||||
| FaxNumber: | 7707815334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2008 | ||||||||
| LastUpdateDate: | 10/03/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 070384 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 003136893C | 05 | GA | MEDICAID |