Provider Demographics
NPI:1154309938
Name:FERNANDO, NISHAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHAN
Middle Name:H
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-205-1331
Mailing Address - Fax:770-205-8727
Practice Address - Street 1:1505 NORTHSIDE BOULEVARD
Practice Address - Street 2:SUITE 4300
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8209
Practice Address - Country:US
Practice Address - Phone:770-205-1331
Practice Address - Fax:770-205-8727
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2020-10-29
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Provider Licenses
StateLicense IDTaxonomies
GA56286207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113316142EMedicaid
GA113316142KMedicaid
GA113316142DMedicaid
GA202I832067Medicare PIN
GA113316142DMedicaid