Basic Information
| Provider Information | |||||||||
| NPI: | 1215101514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKANDAYA | ||||||||
| FirstName: | MANJUNATH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MBBS, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742616 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303742616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702198420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 743 SPRING ST NE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702199000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 08/02/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | D72961 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 01064571A | IN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | 270460 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084A2900X | 90419 | GA | Y | 207RC0200X | 2016-00182 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | 270460 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 2084A2900X | 86242 | SC | N | 2084N0400X | 35.095431 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084A2900X | 2016-00182 | NC | N |
ID Information
| ID | Type | State | Issuer | Description | 333112100 | 05 | MD | MEDICAID | PENDING | 05 | SC | MEDICAID |