Individual
PAVAN MANCHIKALAPATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2509A S MAIN ST, MOULTRIE, GA 31768-6530
(229) 785-2015
Mailing address
PO BOX 1509, MOULTRIE, GA 31776-1509
(229) 785-2015
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
069310
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003135146A
—
GA
Enumeration date
11/09/2005
Last updated
10/14/2013
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