Provider Demographics
NPI:1730173352
Name:IYER, MOHAN N (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:N
Last Name:IYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAN
Other - Middle Name:NARAYANASWAMY
Other - Last Name:IYER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2705 JEFFERSON RD.
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607
Mailing Address - Country:US
Mailing Address - Phone:706-543-3200
Mailing Address - Fax:706-433-1745
Practice Address - Street 1:2705 JEFFERSON RD.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607
Practice Address - Country:US
Practice Address - Phone:706-543-3200
Practice Address - Fax:706-433-1745
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59245207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA841645486AMedicaid
I38763Medicare UPIN
GA841645486AMedicaid
GA841645486AMedicaid