Provider Demographics
NPI:1114774700
Name:PALA, MANYA
Entity type:Individual
Prefix:MS
First Name:MANYA
Middle Name:
Last Name:PALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 UPPER RIVERDALE ROAD, RIVERDALE, GA 30274
Mailing Address - Street 2:SOUTHERN REGIONAL MEDICAL CENTER
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-8570
Mailing Address - Fax:
Practice Address - Street 1:11 UPPER RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2025-01-16
Deactivation Date:2025-01-02
Deactivation Code:
Reactivation Date:2025-01-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program