Provider Demographics
NPI:1508811340
Name:MOHAN, SOWMYA S (MD)
Entity Type:Individual
Prefix:
First Name:SOWMYA
Middle Name:S
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 LENOX WAY NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2862
Mailing Address - Country:US
Mailing Address - Phone:404-357-9898
Mailing Address - Fax:
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 508
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3561
Practice Address - Country:US
Practice Address - Phone:210-541-8281
Practice Address - Fax:210-541-9123
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23084208000000X
GA651462080N0001X
TXS41932080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics