Provider Demographics
NPI:1497709927
Name:MANDIGA, SUDHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:SUDHAKAR
Middle Name:
Last Name:MANDIGA
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 1:7186 WILLIAMS HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-1961
Mailing Address - Country:US
Mailing Address - Phone:706-478-3909
Mailing Address - Fax:706-494-4831
Practice Address - Street 1:7186 WILLIAMS HILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-1961
Practice Address - Country:US
Practice Address - Phone:706-478-3909
Practice Address - Fax:706-494-4831
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34501207L00000X
GA62552207L00000X
AL29936207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA48976OtherBLUE CROSS
IA0277129Medicaid
IA48976OtherBLUE CROSS
IAI6681Medicare ID - Type Unspecified