Individual
MAMTA PANDYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-3013
(706) 721-8623
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5015313
NC
363L00000X
Nurse Practitioner
Primary
GAA-NP000553
GA
363LA2100X
Acute Care Nurse Practitioner
03518
NM
Other
Enumeration date
03/21/2013
Last updated
10/24/2022
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