Healthcare Provider Details

I. General information

NPI: 1730173352
Provider Name (Legal Business Name): MOHAN N IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MOHAN NARAYANASWAMY IYER M.D.

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 JEFFERSON RD.
ATHENS GA
30607
US

IV. Provider business mailing address

2705 JEFFERSON RD.
ATHENS GA
30607
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-3200
  • Fax: 706-433-1745
Mailing address:
  • Phone: 706-543-3200
  • Fax: 706-433-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number59245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: