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General NPI Number Information
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NPI Number | 1386644961
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Entity Type | Individual
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Provider Name | MANJUSHREE GHOSE MD
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 10/07/2011
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Provider Practice Location Address
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Address Line | 1595 CLEVELAND AVE
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City | EAST POINT
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State | GA
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Zip | 30344-3200
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Country | US
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Telephone | 404-616-2886
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Fax | 404-209-1769
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Provider Business Mailing Address
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Address Line | 75 PIEDMONT AVE SUITE 700
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City | ATLANTA
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State | GA
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Zip | 30303-2544
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Country | US
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Telephone | 404-616-1776
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Fax | 404-241-7162
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 042827
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 042827
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License Number State | GA
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