Provider Demographics
NPI:1811006901
Name:MANI, CHITRA S (MD)
Entity type:Individual
Prefix:
First Name:CHITRA
Middle Name:S
Last Name:MANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:785 OHIO AVE STE 3E
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6215
Mailing Address - Country:US
Mailing Address - Phone:662-351-0702
Mailing Address - Fax:662-351-0703
Practice Address - Street 1:785 OHIO AVE STE 3E
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6215
Practice Address - Country:US
Practice Address - Phone:662-351-0702
Practice Address - Fax:662-351-0703
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS27663207Q00000X
GA0505382080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG50538Medicaid
GA000917738AMedicaid
MS200010598Medicaid
SCG50538Medicaid