Provider Demographics
NPI:1053313437
Name:MANI, MURUGIAH R (MD)
Entity Type:Individual
Prefix:DR
First Name:MURUGIAH
Middle Name:R
Last Name:MANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1320 OAKSIDE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2475
Mailing Address - Country:US
Mailing Address - Phone:770-479-2322
Mailing Address - Fax:770-720-7695
Practice Address - Street 1:1320 OAKSIDE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2475
Practice Address - Country:US
Practice Address - Phone:770-479-2322
Practice Address - Fax:770-720-7695
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA019727207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D12472Medicare UPIN
GA72BBBBGMedicare ID - Type Unspecified