Provider Demographics
NPI:1982068904
Name:MOHAPATRA, ANAND (MD)
Entity Type:Individual
Prefix:
First Name:ANAND
Middle Name:
Last Name:MOHAPATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MOHAPATRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3624 J DEWEY GRAY CIR STE 308
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6580
Mailing Address - Country:US
Mailing Address - Phone:706-922-7670
Mailing Address - Fax:706-922-7680
Practice Address - Street 1:3624 J DEWEY GRAY CIR STE 308
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6580
Practice Address - Country:US
Practice Address - Phone:706-922-7670
Practice Address - Fax:706-922-7680
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92217208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology