Provider Demographics
NPI:1992016240
Name:DR PALGHAT V MOHAN MD PC
Entity Type:Organization
Organization Name:DR PALGHAT V MOHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PALGHAT
Authorized Official - Middle Name:V
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-262-8733
Mailing Address - Street 1:970 RAO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-8491
Mailing Address - Country:US
Mailing Address - Phone:770-267-2122
Mailing Address - Fax:770-267-2122
Practice Address - Street 1:357 VILLA PARK CIR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3503
Practice Address - Country:US
Practice Address - Phone:678-262-8733
Practice Address - Fax:888-272-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty