Provider Demographics
NPI:1801851068
Name:MANN, DILRAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:DILRAJ
Middle Name:
Last Name:MANN
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 1:1061 HARMON AVE
Mailing Address - Street 2:INTERNAL MEDICINE CLINIC
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6628
Mailing Address - Fax:912-435-6626
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:INTERNAL MEDICINE CLINIC
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-6628
Practice Address - Fax:912-435-6626
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA038297OtherLICENSE
GA11SCFKBMedicare ID - Type Unspecified
GA038297OtherLICENSE