Provider Demographics
NPI:1902812985
Name:MOHAN, PALGHAT V (MD)
Entity Type:Individual
Prefix:
First Name:PALGHAT
Middle Name:V
Last Name:MOHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 NORTHSIDE XING STE B
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2254
Mailing Address - Country:US
Mailing Address - Phone:855-228-4597
Mailing Address - Fax:855-428-4597
Practice Address - Street 1:2300 NORTHSIDE XING STE B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2254
Practice Address - Country:US
Practice Address - Phone:855-228-4597
Practice Address - Fax:855-428-4597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18110207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000207556EMedicaid
GAD40674Medicare UPIN