Provider Demographics
NPI:1588922728
Name:NOTICEWALA, MANISH SURESH (MD)
Entity type:Individual
Prefix:DR
First Name:MANISH
Middle Name:SURESH
Last Name:NOTICEWALA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8901 STONEBRIDGE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2244
Mailing Address - Country:US
Mailing Address - Phone:943-202-7030
Mailing Address - Fax:470-986-7021
Practice Address - Street 1:8901 STONEBRIDGE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2244
Practice Address - Country:US
Practice Address - Phone:943-202-7030
Practice Address - Fax:470-986-7021
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2022-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY295921207X00000X, 207XX0005X
GA93579207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery