Provider Demographics
NPI:1396755385
Name:WADEHRA, NAVIN PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:NAVIN
Middle Name:PRAKASH
Last Name:WADEHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:531 ROSELANE ST NW STE 710
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-6975
Mailing Address - Country:US
Mailing Address - Phone:678-331-3297
Mailing Address - Fax:678-581-7187
Practice Address - Street 1:6002 PROFESSIONAL PKWY STE 220
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5627
Practice Address - Country:US
Practice Address - Phone:678-715-9690
Practice Address - Fax:678-581-7140
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05834207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA826265683AMedicaid
GA1396755385OtherNPI NUMBER
GA826265683CMedicaid
GA83BBBXZMedicare PIN