Individual provider Active NPI

Mahrukh Jamil, PA

  • Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1285332049
Registry record updated Apr 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12737 Issued in GA
Practice address
1789 Christiana Dr
Lawrenceville, GA 30043-6218
Phone
(404) 916-0964
NPI assigned
Feb 21, 2023
Last updated
Apr 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12737 GA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1789 Christiana Dr
Lawrenceville, GA 30043-6218

Mailing address

1789 Christiana Dr
Lawrenceville, GA 30043-6218
Phone (404) 916-0964

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250411001930 GA Practitioner - Physician Assistant 9032633946 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Houston County Emergency Group, LLC CurrentSince Mar 10, 2025 Accepting new patients

Locations

1601 Watson Blvd
Warner Robins, GA 31093
Phone (478) 322-5155

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1676937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743552000000",
    "number": "1285332049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1789 CHRISTIANA DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436218",
            "telephone_number": "404-916-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1789 CHRISTIANA DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436218",
            "telephone_number": "404-916-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAMIL",
        "first_name": "MAHRUKH",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-21",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12737",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.