Healthcare Provider Details

I. General information

NPI: 1952309049
Provider Name (Legal Business Name): MANJAKKOLLAI P. VEERABAGU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PERPETUAL SQ
ANDERSON SC
29621-1713
US

IV. Provider business mailing address

109 TURNBERRY RD
ANDERSON SC
29621-7652
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-8689
  • Fax: 864-222-1303
Mailing address:
  • Phone: 864-367-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number20-18679
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: