Provider Demographics
NPI:1356664007
Name:PAUL, PANCHAJANYA (MD)
Entity Type:Individual
Prefix:DR
First Name:PANCHAJANYA
Middle Name:
Last Name:PAUL
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:PO BOX 889128
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30356-1128
Mailing Address - Country:US
Mailing Address - Phone:404-294-3835
Mailing Address - Fax:404-508-7795
Practice Address - Street 1:200 WISTERIA DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3827
Practice Address - Country:US
Practice Address - Phone:770-219-5407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0694192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679063580OtherARP MANAGEMENT NPI
1730730839OtherSOUTHERN LIVE OAK NPI