Fazeela Ghannie, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

013167 Issued in GA

Practice address

2000 Riverside Parkway
Suite 200
Lawrenceville, GA 30044

Phone

(678) 836-2109

Fax

(770) 441-0299

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451865600000",
    "number": "1679669188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3194 CLUBSIDE VIEW CT",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300394722",
            "telephone_number": "615-327-9195",
            "fax_number": "770-441-0299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 RIVERSIDE PARKWAY",
            "address_2": "SUITE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "30044",
            "telephone_number": "678-836-2109",
            "fax_number": "770-441-0299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHANNIE",
        "first_name": "FAZEELA",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2016-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "013167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTIST",
            "identifier": "013167",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.