Provider Demographics
NPI:1144904285
Name:PUCHHALAPALLI, MANOGNA (PA-C)
Entity type:Individual
Prefix:
First Name:MANOGNA
Middle Name:
Last Name:PUCHHALAPALLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 HEIRLOOM CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-1636
Mailing Address - Country:US
Mailing Address - Phone:773-680-7669
Mailing Address - Fax:
Practice Address - Street 1:144 BILL CARRUTH PKWY STE 3100
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3819
Practice Address - Country:US
Practice Address - Phone:678-363-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant