Individual
MANJIT PAKKALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1255 HIGHWAY 54 W, FAYETTEVILLE, GA 30214-4526
(404) 367-3014
Mailing address
5325 FARAON ST, SAINT JOSEPH, MO 64506-3488
(816) 271-6406
(816) 271-6789
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
005442
GA
207R00000X
Internal Medicine Physician
0439088
KS
207R00000X
Internal Medicine Physician
2015021659
MO
207R00000X
Internal Medicine Physician
Primary
73446
GA
208M00000X
Hospitalist Physician
2015021659
MO
208M00000X
Hospitalist Physician
73446
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821358003
—
IA
05
—
1821358003
—
MO
05
—
201125270A
—
KS
01
—
P01527145
RR MEDICARE
MO
Enumeration date
05/22/2012
Last updated
08/25/2022
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