Provider Demographics
NPI:1356326961
Name:PAPUDESU, MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:PAPUDESU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3737
Mailing Address - Country:US
Mailing Address - Phone:229-928-3444
Mailing Address - Fax:229-928-3446
Practice Address - Street 1:603 E LAMAR ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3737
Practice Address - Country:US
Practice Address - Phone:229-928-3444
Practice Address - Fax:229-928-3446
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029063207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000968976AMedicaid
GA022135OtherBLUE CROSS BLUE SHIELD
GA05BDKDCMedicare ID - Type Unspecified
GA000968976AMedicaid