Active NPI
Mohammad Reza Nourbakhsh, DPT
- Physical Therapist
- Dahlonega, GA
National Provider Identifier
1295043206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT7497
- Practice address
- 159 Sunset Drive Ste 102
Dahlonega, GA 30597-0000 - Phone
- (706) 482-2268
- Fax
- (706) 482-2294
- NPI assigned
- Sep 24, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT7497 | GA | Primary |
Addresses
Primary practice location
159 Sunset Drive Ste 102
Dahlonega, GA 30597-0000
Mailing address
159 Sunset Dr. Ste 102
Dahlonega, GA 30597-0000
Phone (706) 482-2268
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT7497 | GA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1285286400000",
"number": "1295043206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "159 SUNSET DR. STE 102",
"city": "DAHLONEGA",
"state": "GA",
"postal_code": "305970000",
"telephone_number": "706-482-2268",
"fax_number": "706-482-2294"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "159 SUNSET DRIVE STE 102",
"city": "DAHLONEGA",
"state": "GA",
"postal_code": "305970000",
"telephone_number": "706-482-2268",
"fax_number": "706-482-2294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOURBAKHSH",
"first_name": "MOHAMMAD",
"middle_name": "REZA",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-24",
"last_updated": "2010-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "GA",
"license": "PT7497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dahlonega, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.