Manju Sheriffo Tambajang

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

16651 Issued in GA

Practice address

233 N Houston Rd Ste 140E
Warner Robins, GA 31093-3023

Phone

(478) 975-6880

NPI assigned

Jul 3, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1719964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1881430387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "233 N HOUSTON RD STE 140E",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933023",
            "telephone_number": "478-975-6880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 N HOUSTON RD STE 140E",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310933023",
            "telephone_number": "478-975-6880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "233 N Houston Rd",
            "address_purpose": "LOCATION",
            "city": "Warner Robins",
            "state": "GA",
            "postal_code": "310933074",
            "country_code": "US",
            "telephone_number": "478-975-6880",
            "fax_number": "478-975-6869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAMBAJANG",
        "first_name": "MANJU",
        "middle_name": "SHERIFFO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-03",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "GA",
            "license": "16651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Warner Robins, GA
• Providers in Warner Robins, GA by specialty
• Student in an Organized Health Care Education/Training Program in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.

Verify at the official NPI Registry.