Active NPI
Mitra Mansouri Davis, CNM
- Advanced Practice Midwife
- Atlanta, GA
National Provider Identifier
1164574844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Advanced Practice Midwife
- License
- RN112909
- Practice address
- 1100 Johnson Ferry Rd
Suite 800
Atlanta, GA 30342-1709 - Phone
- (404) 252-1137
- Fax
- (404) 252-6794
- NPI assigned
- Jan 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Advanced Practice Midwife | 367A00000X | RN112909 | GA | Primary |
Addresses
Primary practice location
1100 Johnson Ferry Rd
Suite 800
Atlanta, GA 30342-1709
Mailing address
1100 Johnson Ferry Rd
Suite 800
Atlanta, GA 30342-1709
Phone (404) 252-1137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Mar 1, 2016 through Mar 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Midwife
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN112909 | GA | MD | Advanced Practice Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1454371200000",
"number": "1164574844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 JOHNSON FERRY RD",
"address_2": "SUITE 800",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421709",
"telephone_number": "404-252-1137",
"fax_number": "404-252-6794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 JOHNSON FERRY RD",
"address_2": "SUITE 800",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303421709",
"telephone_number": "404-252-1137",
"fax_number": "404-252-6794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MITRA",
"middle_name": "MANSOURI",
"name_prefix": "Mrs.",
"credential": "CNM",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2016-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "367A00000X",
"taxonomy_group": "",
"desc": "Advanced Practice Midwife",
"state": "GA",
"license": "RN112909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.