Provider Demographics
NPI:1487216164
Name:VYAS, MANAN NILESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANAN
Middle Name:NILESH
Last Name:VYAS
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 1:2532 N DECATUR RD APT 2218
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6185
Mailing Address - Country:US
Mailing Address - Phone:281-686-4962
Mailing Address - Fax:
Practice Address - Street 1:2532 N DECATUR RD APT 2218
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6185
Practice Address - Country:US
Practice Address - Phone:281-686-4962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program