Manjit Pakkala, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

73446 Issued in GA

Practice address

1255 Highway 54 W
Fayetteville, GA 30214-4526

Phone

(404) 367-3014

NPI assigned

May 22, 2012

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Other identifiers 4

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Hospitalist Physicians LLCGroup PAC ID 1951299163, 503 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Piedmont Hospitalist Physicians LLC

  • Family Medicine Physician
  • Stockbridge, GA
  • NPI 1548219660

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Piedmont Athens Hospitalist Physicians LLC

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1578079000
  Medicare reassignment NPD
• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  NPD (past)
• Piedmont Athens Specialty Care LLC

  • Cardiovascular Disease Physician
  • Athens, GA
  • NPI 1184130627
  NPD (past)

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

• Fayette Community Hospital, Inc.

  • General Acute Care Hospital
  • Fayetteville, GA
  • NPI 1528027240
  Care Compare affiliation

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

{
    "created_epoch": "1337644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661385600000",
    "number": "1821358003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5325 FARAON ST",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645063488",
            "telephone_number": "816-271-6406",
            "fax_number": "816-271-6789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 HIGHWAY 54 W",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144526",
            "telephone_number": "404-367-3014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5325 Faraon St",
            "address_purpose": "LOCATION",
            "city": "Saint Joseph",
            "state": "MO",
            "postal_code": "64506",
            "country_code": "US",
            "telephone_number": "816-271-6406",
            "fax_number": "816-271-7986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAKKALA",
        "first_name": "MANJIT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-22",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "2015021659",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "005442",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "0439088",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "73446",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MO",
            "license": "2015021659",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "73446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201125270A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01527145",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821358003",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821358003",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• P & M Transportation
• P E T Imaging of Fayette LLC
• P4 Physical Therapy Limited Partnership
• Tryphena Pacitti, NP
• Donna Page, DOULA
• Dawn Leilani Paletta, PA
• Allane J Palmer, CNA
• Palmetto Family Dental of Fayette County, PC
• Palmetto Sleep PC
• Kashif Panjwani, PHARMD

• Internal Medicine Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.