Provider Demographics
NPI:1548357080
Name:SAHGAL, MONEESHA V (MD)
Entity type:Individual
Prefix:
First Name:MONEESHA
Middle Name:V
Last Name:SAHGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 JOHNS CREEK CT STE D
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6618
Mailing Address - Country:US
Mailing Address - Phone:770-622-7742
Mailing Address - Fax:770-622-7743
Practice Address - Street 1:3925 JOHNS CREEK CT STE D
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6618
Practice Address - Country:US
Practice Address - Phone:770-622-7422
Practice Address - Fax:770-622-7743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058322208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA289041155AMedicaid