MEDICARE: MRS. ANU R MONGIA 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	207KA0200X	Allergy Physician	13396-320	WI
2	207KA0200X	Allergy Physician	055685	GA

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	:	1659332922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANU R MONGIA MD

Provider Business Mailing Address
First Line	:	100 MARKET PLACE BLVD
Second Line	:	STE 207
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-8718
Country	:	US
Telephone Number	:	770-607-7430
Fax Number	:	678-721-6974

Provider Business Practice Location Address
First Line	:	100 MARKET PLACE BLVD
Second Line	:	STE 207
City	:	CARTERSVILLE
State	:	GA
Zip	:	30121-8718
Country	:	US
Telephone Number	:	770-607-7430
Fax Number	:	678-721-6974

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	04/10/2025

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