Provider Demographics
NPI:1407052160
Name:TAH, NEAL CHANDER (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:CHANDER
Last Name:TAH
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 1:101 RIVERSTONE VIS STE 300
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6683
Mailing Address - Country:US
Mailing Address - Phone:706-258-4178
Mailing Address - Fax:
Practice Address - Street 1:101 RIVERSTONE VIS STE 211
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-6665
Practice Address - Country:US
Practice Address - Phone:706-632-3670
Practice Address - Fax:706-632-5928
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC299144Medicaid
SCP00871181OtherRAILROAD MEDICARE
CO24125041Medicaid
CO24125041Medicaid
CO542028YL0XMedicare PIN