Provider Demographics
NPI:1114985967
Name:NAIK, MADHAVI M (MD)
Entity Type:Individual
Prefix:
First Name:MADHAVI
Middle Name:M
Last Name:NAIK
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 1:106 LUKKEN INDUSTRIAL DR W
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-5912
Mailing Address - Country:US
Mailing Address - Phone:706-880-7204
Mailing Address - Fax:706-880-7289
Practice Address - Street 1:106 LUKKEN INDUSTRIAL DR W
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-5912
Practice Address - Country:US
Practice Address - Phone:706-880-7204
Practice Address - Fax:706-880-7289
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048548174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA160049424OtherRAILROAD MEDICARE
GA00012515DMedicaid
GA728872OtherBLUE CROSS BLUE SHIELD
GA160049424OtherRAILROAD MEDICARE
GA728872OtherBLUE CROSS BLUE SHIELD