1578724886 NPI number — AMAR MOHAN MD

Table of content: AMAR MOHAN MD (NPI 1578724886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578724886 NPI number — AMAR MOHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHAN
Provider First Name:
AMAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1578724886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10911 RAVEN RIDGE RD STE 103-93
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27614-8362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-734-8193
Provider Business Mailing Address Fax Number:
404-328-7339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
704 BREEDLOVE DR
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-2054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-772-0076
Provider Business Practice Location Address Fax Number:
770-751-8014
Provider Enumeration Date:
06/19/2008

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: 207R00000X , with the licence number:  35.097246 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 2024-03298 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 66531 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810022470 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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