Provider Demographics
NPI:1396639480
Name:MANDIP MEDIPSYCH HEALTH SERVICES
Entity type:Organization
Organization Name:MANDIP MEDIPSYCH HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:MANDIP
Authorized Official - Last Name:EGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-854-8533
Mailing Address - Street 1:3042 HOLLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6222
Mailing Address - Country:US
Mailing Address - Phone:470-854-8533
Mailing Address - Fax:470-690-2310
Practice Address - Street 1:850 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7218
Practice Address - Country:US
Practice Address - Phone:470-854-8533
Practice Address - Fax:470-690-2310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty