Individual provider Active NPI

Manogna Puchhalapalli, PA-C

  • Physician Assistant
  • Hiram, GA
National Provider Identifier
1144904285
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
144 Bill Carruth Pkwy Ste 3100
Hiram, GA 30141-3819
Phone
(678) 363-1940
NPI assigned
Jun 9, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

144 Bill Carruth Pkwy Ste 3100
Hiram, GA 30141-3819

Mailing address

1833 Heirloom CT
Marietta, GA 30066-1636
Phone (773) 680-7669

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240131000558 GA Practitioner - Physician Assistant 3375996960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

144 Bill Carruth Pkwy
Hiram, GA 30141-3819

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (770) 732-4022

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

Hospital & facility affiliations

  • Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
  • Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Feb 1, 2024 Accepting new patients
Wellstar Medical Group, LLC CurrentSince Feb 1, 2024 Accepting new patients
Wellstar Cardiovascular Medicine, LLC Past Accepting new patients

Locations

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

144 Bill Carruth Pkwy
Ste 3100
Hiram, GA 30141
Phone (678) 363-1940

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (470) 644-7000

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686268800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1144904285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1833 HEIRLOOM CT",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300661636",
            "telephone_number": "773-680-7669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 BILL CARRUTH PKWY STE 3100",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413819",
            "telephone_number": "678-363-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCHHALAPALLI",
        "first_name": "MANOGNA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-09",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hiram, GA

Sources for this page

Verify at the official NPI Registry.