Provider Demographics
NPI:1689866386
Name:MOHAN PAPUDESU MD
Entity type:Organization
Organization Name:MOHAN PAPUDESU MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPUDESU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-553-0505
Mailing Address - Street 1:610 FERNCREST DR
Mailing Address - Street 2:
Mailing Address - City:SANDERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31082-1863
Mailing Address - Country:US
Mailing Address - Phone:478-553-0505
Mailing Address - Fax:478-553-0708
Practice Address - Street 1:610 FERNCREST DR
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-1863
Practice Address - Country:US
Practice Address - Phone:478-553-0505
Practice Address - Fax:478-553-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6539Medicare PIN