Provider Demographics
NPI:1811088842
Name:BAKANE, NEELA R (MD)
Entity type:Individual
Prefix:
First Name:NEELA
Middle Name:R
Last Name:BAKANE
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 1:2878 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:678-344-8700
Mailing Address - Fax:678-344-8600
Practice Address - Street 1:10160 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUIE 100
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4419
Practice Address - Country:US
Practice Address - Phone:678-387-1600
Practice Address - Fax:678-344-8600
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA056973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA056973OtherMEDICAL LISENCE
VA010211131OtherMEDICAID MEDALLION
VA010211131Medicaid
WVF85989Medicare UPIN
VA010211131Medicaid