Provider Demographics
NPI:1730249616
Name:MINA NAYAK M.D. PC
Entity type:Organization
Organization Name:MINA NAYAK M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-715-8500
Mailing Address - Street 1:4904 TIMBER RIDGE DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1831
Mailing Address - Country:US
Mailing Address - Phone:678-715-8500
Mailing Address - Fax:770-489-7884
Practice Address - Street 1:4904 TIMBER RIDGE DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1831
Practice Address - Country:US
Practice Address - Phone:678-715-8500
Practice Address - Fax:770-489-7884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032004207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000438248CMedicaid
GA000438248CMedicaid