Provider Demographics
NPI:1083893713
Name:TAKAWIRA, NGANO TONGESAI FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:NGANO
Middle Name:TONGESAI FRANK
Last Name:TAKAWIRA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1700 MEDICAL WAY
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2195
Mailing Address - Country:US
Mailing Address - Phone:770-979-9996
Mailing Address - Fax:770-979-1202
Practice Address - Street 1:1090 RIVER LAUREL DR
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024
Practice Address - Country:US
Practice Address - Phone:770-979-9996
Practice Address - Fax:770-979-1202
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD43272207R00000X
GA73500208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine