Provider Demographics
NPI:1588625099
Name:KRISHNAMACHARY, MOHAN K (MD)
Entity Type:Individual
Prefix:
First Name:MOHAN
Middle Name:K
Last Name:KRISHNAMACHARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-495-3396
Mailing Address - Fax:770-495-2307
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1828
Practice Address - Country:US
Practice Address - Phone:770-623-8965
Practice Address - Fax:770-623-4018
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN47934207RX0202X
GA057094207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003121786EMedicaid
GA003121786FMedicaid
GA003121786EMedicaid
TN103I831261Medicare PIN
GAI 51086Medicare UPIN