1801631288 NPI number — ANITA MANI MEDEPALLI MEDICAL STUDENT

Table of content: ANITA MANI MEDEPALLI MEDICAL STUDENT (NPI 1801631288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801631288 NPI number — ANITA MANI MEDEPALLI MEDICAL STUDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEDEPALLI
Provider First Name:
ANITA
Provider Middle Name:
MANI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MEDICAL STUDENT
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:
1801631288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 CARUSO CT
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:
30350-6608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-331-0323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31207-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-301-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2024

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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