Provider Demographics
NPI:1902914591
Name:MANN, AMARDEEP S (MD)
Entity Type:Individual
Prefix:MR
First Name:AMARDEEP
Middle Name:S
Last Name:MANN
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 1:1115 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2905
Mailing Address - Country:US
Mailing Address - Phone:478-988-3060
Mailing Address - Fax:478-988-3098
Practice Address - Street 1:1115 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-988-3060
Practice Address - Fax:478-988-3098
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA902441925BMedicaid
GA058282OtherMEDICAL LICENSE
GA058282OtherMEDICAL LICENSE
GAI61494Medicare UPIN