Provider Demographics
NPI:1295893873
Name:PANDYA, GANESH PRANSHANKAR (MD)
Entity type:Individual
Prefix:DR
First Name:GANESH
Middle Name:PRANSHANKAR
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742322
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2322
Mailing Address - Country:US
Mailing Address - Phone:770-942-4822
Mailing Address - Fax:770-942-5311
Practice Address - Street 1:4904 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1826
Practice Address - Country:US
Practice Address - Phone:770-942-4822
Practice Address - Fax:770-942-5311
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I020054Medicare PIN
E45052Medicare UPIN