NPIMap

Individual provider Active NPI

Ambreen Mardhani

  • Family Medicine Physician
  • Canton, GA
National Provider Identifier
1043657521
Registry record updated Aug 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
075722 Issued in GA
Practice address
104 Prominence Point Pkwy
Suite 104
Canton, GA 30114-1236
Phone
(770) 704-6988
NPI assigned
May 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 075722 GA Primary

Addresses

Primary practice location

104 Prominence Point Pkwy
Suite 104
Canton, GA 30114-1236

Mailing address

104 Prominence Point Pkwy
Suite 104
Canton, GA 30114-1236
Phone (770) 704-6988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161004002587 GA Practitioner - Family Practice 2365665635 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Piedmont Medical Care CorporationGroup PAC ID 6002802220, 368 clinicians
Piedmont Professional Services LLCGroup PAC ID 8921176231, 171 clinicians

Practice addresses (Care Compare)

105 Collier Rd NW
Suite 5020
Atlanta, GA 30309-1731
Phone (404) 367-3210

15 Reinhardt College Pkwy
Suite 100
Canton, GA 30114-5259
Phone (770) 704-6988

1855 Hudson Bridge Rd
Stockbridge, GA 30281-5000
Phone (770) 801-2500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
075722GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Professional Services, LLC Family Medicine CurrentSince Feb 8, 2026 Accepting new patients
Piedmont Medical Care Corporation Family Medicine CurrentSince Sep 19, 2016 Accepting new patients
Piedmont Providers LLC Past Accepting new patients

Locations

105 Collier Rd NW
Ste 2070
Atlanta, GA 30309
Phone (404) 350-3860

2727 Paces Ferry Rd SE
Ste 1-1100
Atlanta, GA 30339
Phone (470) 271-3421

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

104 Prominence Point Pkwy
Ste 104
Canton, GA 30114
Phone (770) 704-6988

15 Reinhardt College Pkwy
Ste 110A
Canton, GA 30114
Phone (770) 720-2383

1855 Hudson Bridge Rd
Stockbridge, GA 30281
Phone (678) 565-0648

Organizations & group practices 3

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 8

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": "1369353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1043657521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 PROMINENCE POINT PKWY",
            "address_2": "SUITE 104",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301141236",
            "telephone_number": "770-704-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 PROMINENCE POINT PKWY",
            "address_2": "SUITE 104",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301141236",
            "telephone_number": "770-704-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARDHANI",
        "first_name": "AMBREEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-24",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "075722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.