Individual
NEELA R BAKANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10160 MEDLOCK BRIDGE RD, SUIE 100, JOHNS CREEK, GA 30097-4419
(678) 387-1600
(678) 344-8600
Mailing address
2878 FIVE FORKS TRICKUM RD, SUITE 2A, LAWRENCEVILLE, GA 30044-5896
(678) 344-8700
(678) 344-8600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056973
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010211131
MEDICAID MEDALLION
VA
05
—
010211131
—
VA
01
—
056973
MEDICAL LISENCE
GA
Enumeration date
09/27/2006
Last updated
04/19/2012
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