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Individual

DR. MUTHIAH KRISHNASAMY SABANAYAGAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
916 ELEVENTH ST, GOLDSBORO, NC 27534-1616
(919) 735-9119
(919) 735-9120
Mailing address
1000 CLARA CT, GOLDSBORO, NC 27530-8121
(919) 735-9119

Taxonomy

Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
31639
NC
2084P0800X
Psychiatry Physician
Primary
31639
NC
2084P0802X
Addiction Psychiatry Physician
31639
NC
2084P0804X
Child & Adolescent Psychiatry Physician
31639
NC
2084P0805X
Geriatric Psychiatry Physician
31639
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
372582
MANAGED HEALTH NETWORK
NC
05
8974152
NC
Enumeration date
05/17/2006
Last updated
02/15/2014
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