Provider Demographics
NPI:1184677031
Name:MONAHAN, NAN R (MD)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:R
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 150
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-355-1966
Mailing Address - Fax:404-603-2801
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 150
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-355-1966
Practice Address - Fax:404-603-2801
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA041467207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG57821Medicare UPIN
GA11BDSWHMedicare ID - Type Unspecified