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General NPI Number Information
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NPI Number | 1588625099
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Entity Type | Individual
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Provider Name | MOHAN K KRISHNAMACHARY MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2006
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Last Update Date | 03/09/2021
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Provider Practice Location Address
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Address Line | 6300 HOSPITAL PKWY SUITE 300
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City | JOHNS CREEK
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State | GA
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Zip | 30097-1828
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Country | US
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Telephone | 770-623-8965
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Fax | 770-623-4018
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Provider Business Mailing Address
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Address Line | 1835 SAVOY DR SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30341-1072
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Country | US
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Telephone | 770-495-3396
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Fax | 770-495-2307
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 47934
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 057094
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License Number State | GA
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