Organization
SHASHI MADAN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SYLVIA THOMPSON (OFFICE MASNAGER)
(770) 775-7675
Entity
Organization
Contact information
Practice address
135 N OAK ST, JACKSON, GA 30233-1942
(770) 775-7675
Mailing address
135 N OAK ST, JACKSON, GA 30233-1942
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
037279
GA
251E00000X
Home Health Agency
037279
GA
302R00000X
Health Maintenance Organization
Primary
037279
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000568554B
—
GA
Enumeration date
06/22/2010
Last updated
06/22/2010
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