Provider Demographics
NPI:1013538040
Name:BANSAL, MEHAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHAK
Middle Name:
Last Name:BANSAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-1482
Mailing Address - Country:US
Mailing Address - Phone:404-301-4555
Mailing Address - Fax:404-301-4482
Practice Address - Street 1:1057 MAIN ST
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-1482
Practice Address - Country:US
Practice Address - Phone:404-301-4555
Practice Address - Fax:404-301-4482
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-08-21
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-01-25
Provider Licenses
StateLicense IDTaxonomies
GA96697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine