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General NPI Number Information
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NPI Number | 1245628809
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Entity Type | Organization
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Legal Business Name | MAHENDRA G AMIN MD PC
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 1022 BRYAN ST W
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City | DOUGLAS
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State | GA
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Zip | 31533-2328
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Country | US
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Telephone | 912-632-2117
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 BRYAN ST W
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City | DOUGLAS
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State | GA
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Zip | 31533-2328
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Country | US
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Telephone | 912-632-2117
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Fax |
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Authorized Official
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Title or Position | MANGER
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Name | MRS. KAREN SUE DOUGLAS
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Credential |
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Telephone | 912-632-2117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 027483
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License Number State | GA
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