Individual
ANNAMMA T. MAMMEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-4588
(706) 721-7264
Mailing address
1499 WALTON WAY, STE 1400, AUGUSTA, GA 30901-2602
(706) 828-6410
(706) 722-5187
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036652
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000544475A
—
GA
05
—
G36652
—
SC
Enumeration date
08/30/2006
Last updated
03/30/2011
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