Provider Demographics
NPI:1528036316
Name:MAINTHIA, NANDITA (MD)
Entity Type:Individual
Prefix:DR
First Name:NANDITA
Middle Name:
Last Name:MAINTHIA
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 1:1810 MULKEY RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:770-944-8660
Mailing Address - Fax:770-944-8661
Practice Address - Street 1:1810 MULKEY RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-944-8660
Practice Address - Fax:770-944-8661
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00468894BMedicaid
GAGRP356Medicare ID - Type Unspecified
GA00468894BMedicaid