Provider Demographics
NPI:1588625248
Name:NAYAK, MINA C (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:C
Last Name:NAYAK
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 1:8954 HOSPITAL DR
Mailing Address - Street 2:SUITE D-125
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2272
Mailing Address - Country:US
Mailing Address - Phone:678-715-8500
Mailing Address - Fax:770-489-7884
Practice Address - Street 1:8954 HOSPITAL DR
Practice Address - Street 2:SUITE D-125
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2272
Practice Address - Country:US
Practice Address - Phone:678-715-8500
Practice Address - Fax:770-489-7884
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032004207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52281682OtherBLUE CROSS
GA00438248CMedicaid
GA00438248CMedicaid
GAB64804Medicare UPIN