Provider Demographics
NPI:1144988684
Name:CHANGELA, MIHIR
Entity type:Individual
Prefix:MR
First Name:MIHIR
Middle Name:
Last Name:CHANGELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 FOREST GROVE TRL NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6690
Mailing Address - Country:US
Mailing Address - Phone:678-995-2989
Mailing Address - Fax:
Practice Address - Street 1:457 NATHAN DEAN BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-4911
Practice Address - Country:US
Practice Address - Phone:770-443-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH033393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH033393OtherPHARMACIST LICENSE NUMBER