Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 029063 | GA |
NPI | 1356326961 |
---|---|
Provider Name | Dr. Mohan Papudesu |
First Address | Americus, GA 31709-3737 |
Second Address | Americus, GA 31709-3737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000968976A | (05) | GA |
022135 | BLUE CROSS BLUE SHIELD (01) | GA |
D28664 | (02) | GA |