Healthcare Provider Details

I. General information

NPI: 1992016240
Provider Name (Legal Business Name): DR PALGHAT V MOHAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 VILLA PARK CIR
STONE MOUNTAIN GA
30087-3503
US

IV. Provider business mailing address

970 RAO DR SUITE A
MONROE GA
30655-8491
US

V. Phone/Fax

Practice location:
  • Phone: 678-262-8733
  • Fax: 888-272-8899
Mailing address:
  • Phone: 770-267-2122
  • Fax: 770-267-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PALGHAT V MOHAN
Title or Position: DIRECTOR
Credential: MD
Phone: 678-262-8733