Active NPI
Manuel Nick Tissura
- Endodontics
- Decatur, GA
National Provider Identifier
1295981165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 6927
- Practice address
- 2771 Lawrenceville Hwy
Suite 201
Decatur, GA 30033-2530 - Phone
- (678) 990-8034
- Fax
- (770) 934-7176
- NPI assigned
- Aug 12, 2008
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 6927 | GA | Primary |
Addresses
Primary practice location
2771 Lawrenceville Hwy
Suite 201
Decatur, GA 30033-2530
Mailing address
2771 Lawrenceville Hwy
Suite 201
Decatur, GA 30033-2530
Phone (678) 990-8034
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 |
|---|---|---|---|
| 6927 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1218499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1218499200000",
"number": "1295981165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2771 LAWRENCEVILLE HWY",
"address_2": "SUITE 201",
"city": "DECATUR",
"state": "GA",
"postal_code": "300332530",
"telephone_number": "678-990-8034",
"fax_number": "770-934-7176"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2771 LAWRENCEVILLE HWY",
"address_2": "SUITE 201",
"city": "DECATUR",
"state": "GA",
"postal_code": "300332530",
"telephone_number": "678-990-8034",
"fax_number": "770-934-7176"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISSURA",
"first_name": "MANUEL",
"middle_name": "NICK",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-12",
"last_updated": "2008-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "6927",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.