Provider Demographics
NPI:1902818073
Name:NAYAK, MANEL DINESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANEL
Middle Name:DINESH
Last Name:NAYAK
Suffix:
Gender:M
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:PO BOX 1525
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-1525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2005 PIONEER ST
Practice Address - Street 2:SUITE C
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6206
Practice Address - Country:US
Practice Address - Phone:912-338-9704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025931207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000531517DMedicaid
GA000531517AMedicaid
B19891Medicare UPIN
29BDBNWMedicare ID - Type UnspecifiedMEDICARE NUMBER
GA000531517DMedicaid