1447679824 NPI number — DR. JYOTI MANI M.D.

Table of content: DR. JYOTI MANI M.D. (NPI 1447679824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447679824 NPI number — DR. JYOTI MANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANI
Provider First Name:
JYOTI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447679824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 744785
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-4785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-476-5000
Provider Business Mailing Address Fax Number:
267-425-9299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MICHIGAN AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-476-5000
Provider Business Practice Location Address Fax Number:
215-453-4738
Provider Enumeration Date:
04/14/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0206X , with the licence number:  MD046418 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1033555300001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".