Active NPI
Niketa Raj Manda
- Student in an Organized Health Care Education/Training Program
- Atlanta, GA
National Provider Identifier
1104528777
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 49 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3049 - Phone
- (404) 778-1440
- NPI assigned
- Mar 20, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
49 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3049
Mailing address
7832 Amawalk Cir
Johns Creek, GA 30097-1918
Phone (770) 530-7854
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230721003461 | GA | Order and Referring Only - Pediatric Medicine | 9234599226 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783555200000",
"number": "1104528777",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7832 AMAWALK CIR",
"city": "JOHNS CREEK",
"state": "GA",
"postal_code": "300971918",
"telephone_number": "770-530-7854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 JESSE HILL JR DR SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303033049",
"telephone_number": "404-778-1440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANDA",
"first_name": "NIKETA",
"middle_name": "RAJ",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2026-07-09",
"certification_date": "2026-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.