Individual provider Active NPI

Pooja Maknoor

  • Nephrology Physician
  • Fayetteville, GA
National Provider Identifier
1013531946
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
102685 Issued in GA
Practice address
1275 Highway 54 W Ste 100
Fayetteville, GA 30214-4538
Phone
(678) 817-5542
NPI assigned
Jun 6, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X 102685 GA Primary

Addresses

Primary practice location

1275 Highway 54 W Ste 100
Fayetteville, GA 30214-4538

Mailing address

1275 Highway 54 W Ste 100
Fayetteville, GA 30214-4538
Phone (678) 817-5542

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250603003387 GA Practitioner - Nephrology 0345609921 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nephrology Consultants of Georgia, P.C.Group PAC ID 7012903800, 13 clinicians

Practice addresses (Care Compare)

1275 Hwy 54 W
Suite 100
Fayetteville, GA 30214-4538
Phone (678) 817-5542

Hospital & facility affiliations

  • Piedmont Fayette Hospital Hospital, Fayetteville, GA, CCN 110215
  • Piedmont Newnan Hospital, Inc Hospital, Newnan, GA, CCN 110229

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
102685GAMDNephrology Physician

Organizations & group practices 1

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": "1591401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1013531946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W STE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144538",
            "telephone_number": "678-817-5542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 HIGHWAY 54 W STE 100",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144538",
            "telephone_number": "678-817-5542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKNOOR",
        "first_name": "POOJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-06",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "GA",
            "license": "102685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.