Provider Demographics
NPI:1841499639
Name:MANEKAR MEDICAL CLINIC PA
Entity type:Organization
Organization Name:MANEKAR MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-351-0698
Mailing Address - Street 1:1430 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-8182
Mailing Address - Country:US
Mailing Address - Phone:770-351-0698
Mailing Address - Fax:309-422-8868
Practice Address - Street 1:1430 FIVE FORKS TRICKUM RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8182
Practice Address - Country:US
Practice Address - Phone:770-351-0698
Practice Address - Fax:309-422-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057099174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI66535Medicare UPIN