Provider Demographics
NPI:1235101072
Name:MONGIA, AMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:AMAN
Middle Name:
Last Name:MONGIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 MARKET PLACE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8718
Mailing Address - Country:US
Mailing Address - Phone:678-721-6971
Mailing Address - Fax:678-721-6974
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:678-721-6971
Practice Address - Fax:678-721-6974
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055510207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI27288Medicare UPIN
537453433AMedicare ID - Type Unspecified
GAGRP7053Medicare ID - Type Unspecified