Provider Demographics
NPI:1659332922
Name:MONGIA, ANU R (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANU
Middle Name:R
Last Name:MONGIA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 MARKET PLACE BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8718
Mailing Address - Country:US
Mailing Address - Phone:770-607-7430
Mailing Address - Fax:678-721-6974
Practice Address - Street 1:100 MARKET PLACE BLVD
Practice Address - Street 2:STE 207
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8718
Practice Address - Country:US
Practice Address - Phone:770-607-7430
Practice Address - Fax:678-721-6974
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA055685207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA915720405BMedicaid