Provider Demographics
NPI:1619003902
Name:BCGP
Entity type:Organization
Organization Name:BCGP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSITADZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-923-6400
Mailing Address - Street 1:976 KILLIAN HILL RD SW
Mailing Address - Street 2:BUILDING A, SUITE B
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3102
Mailing Address - Country:US
Mailing Address - Phone:770-923-6400
Mailing Address - Fax:
Practice Address - Street 1:976 KILLIAN HILL RD SW
Practice Address - Street 2:BUILDING A, SUITE B
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3102
Practice Address - Country:US
Practice Address - Phone:770-923-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052456174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty