Provider Demographics
NPI:1437318524
Name:CHAND, GOTAM (MD)
Entity type:Individual
Prefix:DR
First Name:GOTAM
Middle Name:
Last Name:CHAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 JADE DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9465
Mailing Address - Country:US
Mailing Address - Phone:516-941-7451
Mailing Address - Fax:
Practice Address - Street 1:1350 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2612
Practice Address - Country:US
Practice Address - Phone:706-774-5795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64346208M00000X
GA064346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA513967754AMedicaid
GA111919Medicare Oscar/Certification
GA202I083742Medicare PIN
GA111889Medicare Oscar/Certification
GA111830Medicare Oscar/Certification
GA513967754AMedicaid
GA111887Medicare Oscar/Certification
GA111904Medicare Oscar/Certification