Organization
MUKUL KHURANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUKUL KHURANA (PROVIDER ENROLLMENT COORDINATOR)
(229) 873-3296
Entity
Organization
Contact information
Practice address
780 26TH AVE SE, MOULTRIE, GA 31768-6799
(229) 873-3296
(229) 873-3297
Mailing address
780 26TH AVE SE, MOULTRIE, GA 31768-6799
(229) 873-3296
(229) 873-3297
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
058975
GA
Other
Enumeration date
04/25/2008
Last updated
05/12/2010
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