Provider Demographics
NPI:1265483952
Name:MANHIANI, RAJWINDER S (MD)
Entity Type:Individual
Prefix:
First Name:RAJWINDER
Middle Name:S
Last Name:MANHIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2750
Mailing Address - Street 2:STE 106
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2750
Mailing Address - Country:US
Mailing Address - Phone:803-233-4673
Mailing Address - Fax:803-233-4673
Practice Address - Street 1:4412 COLUMBIA RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-4562
Practice Address - Country:US
Practice Address - Phone:706-210-9990
Practice Address - Fax:706-210-0771
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-01461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902440Medicaid
NC2050227Medicare ID - Type Unspecified
NC5902440Medicaid