Provider Demographics
NPI:1154397313
Name:VIJ, MEENAKSHI (MD)
Entity type:Individual
Prefix:
First Name:MEENAKSHI
Middle Name:
Last Name:VIJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEENAKSHI
Other - Middle Name:
Other - Last Name:GUPTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:119 RED OAK TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-845-3175
Mailing Address - Fax:
Practice Address - Street 1:1514 VERNON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4131
Practice Address - Country:US
Practice Address - Phone:706-845-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108753207ZP0102X
NY307517-01207ZP0102X
GA053914207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00287040OtherRAILROAD MEDICARE
GA615008625BMedicaid
GA22BDDSJMedicare PIN