MEDICARE: DR. MANISHA GARG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	34994	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215215389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANISHA GARG MD

Provider Business Mailing Address
First Line	:	301 BROWN SPRINGS RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7005
Country	:	US
Telephone Number	:	334-747-4159
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 E SOUTH BLVD
Second Line	:	SUITE 200
City	:	MONTGOMERY
State	:	AL
Zip	:	36116-2454
Country	:	US
Telephone Number	:	334-613-7070
Fax Number	:	334-613-7072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2011
Last Update Date	:	01/06/2023

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