Provider Demographics
NPI:1396782827
Name:MANKAN, NAGENDER (MD)
Entity type:Individual
Prefix:DR
First Name:NAGENDER
Middle Name:
Last Name:MANKAN
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 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:2500 HOSPITAL BLVD STE 490
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4975
Practice Address - Country:US
Practice Address - Phone:470-321-7500
Practice Address - Fax:778-355-4474
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057887207RH0003X
TXP2726207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1396782827OtherNPI NUMBER
TX323375Medicare PIN
GAI55879Medicare UPIN
TX3287005-01Medicaid
GAHOSP24OtherCAHABA
GA562878980AMedicaid