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NPI Code Detail

MEDICARE: MANJUSHREE GHOSE MD

MEDICARE: MANJUSHREE GHOSE 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
12083P0901XPublic Health & General Preventive Medicine Physician042827GA
2207Q00000XFamily Medicine Physician042827GA

Other Identifiers

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

General Provider Information

NPI Number : 1386644961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANJUSHREE GHOSE MD
Provider Business Mailing Address
First Line : 75 PIEDMONT AVE
Second Line : SUITE 700
City : ATLANTA
State : GA
Zip : 30303-2544
Country : US
Telephone Number : 404-616-1776
Fax Number : 404-241-7162
Provider Business Practice Location Address
First Line : 1595 CLEVELAND AVE
Second Line :
City : EAST POINT
State : GA
Zip : 30344-3200
Country : US
Telephone Number : 404-616-2886
Fax Number : 404-209-1769
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2005
Last Update Date : 10/07/2011

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