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General NPI Number Information
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NPI Number | 1811088842
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Entity Type | Individual
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Provider Name | NEELA R BAKANE MD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 10160 MEDLOCK BRIDGE RD SUIE 100
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City | JOHNS CREEK
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State | GA
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Zip | 30097-4419
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Country | US
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Telephone | 678-387-1600
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Fax | 678-344-8600
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Provider Business Mailing Address
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Address Line | 2878 FIVE FORKS TRICKUM RD SUITE 2A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-5896
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Country | US
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Telephone | 678-344-8700
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Fax | 678-344-8600
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 056973
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License Number State | GA
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