Active NPI
Karim Mamdouh Ghanem, PHYSICIAN ASSISTANT
- Physician Assistant
- Atlanta, GA
National Provider Identifier
1730535154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 5665 New Northside Drive
Suite 320
Atlanta, GA 30328 - Phone
- (770) 874-5408
- NPI assigned
- May 5, 2016
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
5665 New Northside Drive
Suite 320
Atlanta, GA 30328
Mailing address
P.O. Box 27
37 Jones Street
Boydton, VA 23917
Phone (919) 621-3469
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: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462406400000",
"number": "1730535154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 27",
"address_2": "37 JONES STREET",
"city": "BOYDTON",
"state": "VA",
"postal_code": "23917",
"telephone_number": "919-621-3469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5665 NEW NORTHSIDE DRIVE",
"address_2": "SUITE 320",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30328",
"telephone_number": "770-874-5408"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHANEM",
"first_name": "KARIM",
"middle_name": "MAMDOUH",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-05",
"last_updated": "2016-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"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 May 5, 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.