Provider Demographics
NPI:1437393873
Name:CHAUDHRY, ABDUL MANNAN (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:MANNAN
Last Name:CHAUDHRY
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:DR
Other - First Name:MANNAN
Other - Middle Name:
Other - Last Name:CHAUDHRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MPH
Mailing Address - Street 1:PO BOX 102321
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1412 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3877
Practice Address - Country:US
Practice Address - Phone:770-918-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255321207R00000X
GA68709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1437393873Medicaid
VA1437393873Medicaid