MEDICARE: LEENA PRAVIN MANE 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	207Q00000X	Family Medicine Physician	61485	GA

General Provider Information

NPI Number	:	1902081755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEENA PRAVIN MANE MD

Provider Business Mailing Address
First Line	:	11 DUNWOODY PARK
Second Line	:	SUITE 150
City	:	DUNWOODY
State	:	GA
Zip	:	30338-7408
Country	:	US
Telephone Number	:	404-778-6920
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 DUNWOODY PARK
Second Line	:	SUITE 150
City	:	DUNWOODY
State	:	GA
Zip	:	30338-7408
Country	:	US
Telephone Number	:	404-778-6920
Fax Number	:

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

Provider Enumeration Date	:	12/28/2007
Last Update Date	:	12/08/2015

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