Healthcare Provider Details

I. General information

NPI: 1053304634
Provider Name (Legal Business Name): MONA BATRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 BRUSH CREEK CT
LAGRANGE GA
30240-8146
US

IV. Provider business mailing address

105 BRUSH CREEK CT
LAGRANGE GA
30240-8146
US

V. Phone/Fax

Practice location:
  • Phone: 706-416-2490
  • Fax:
Mailing address:
  • Phone: 706-416-2490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50763
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56591
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number062948
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036110254
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number062948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: