Individual
ANISHA MANDAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
100 MCWILLAMS DRIVE, PEACHTREE CITY, GA 30269
(770) 702-1864
(833) 305-0287
Mailing address
100 MCWILLAMS DRIVE, PEACHTREE CITY, GA 30269
(770) 702-1864
(833) 305-0287
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
14458
NV
207RC0000X
Cardiovascular Disease Physician
Primary
95772
GA
208M00000X
Hospitalist Physician
047099
CT
208M00000X
Hospitalist Physician
250978
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11939090
CAQH
—
01
—
P01198011
RAILROAD M'CARE
—
Enumeration date
01/14/2009
Last updated
07/03/2024
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