Individual
ELISA PRATIMA MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
764 PINE ST, MACON, GA 31201-2107
(478) 301-5824
Mailing address
764 PINE ST, MACON, GA 31201-2107
(478) 301-5824
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10590
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/18/2018
Last updated
06/24/2019
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