NPIMap

Individual provider Active NPI

Fatimah Manzoor, MD

  • Internal Medicine Physician
  • Gainesville, GA
National Provider Identifier
1750502357
Registry record updated Jul 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
064600 Issued in GA
Practice address
725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Phone
(770) 535-0191
Fax
(770) 535-0916
NPI assigned
May 1, 2007
Last updated
Jul 22, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 6241 KS
Internal Medicine Physician 207R00000X 064600 GA Primary

Addresses

Primary practice location

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834

Mailing address

PO Box 658
Gainesville, GA 30503-0658
Phone (770) 718-1122

Other identifiers 6

IdentifierTypeStateIssuer
588865OtherGAWELLCARE
01401428OtherGAAMERIGROUP
P00903602OtherGAMEDICARE RAILROAD
003100463AMedicaidGA
1700011OtherGACIGNA
52497649OtherGABCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100812000945 GA Practitioner - Internal Medicine 8921132952 Reassigns benefits to 2 organizations
Practice locations: Gainesville, GA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Longstreet Clinic, PCGroup PAC ID 2668465733, 140 clinicians
Northeast Georgia Community Physicians LLCGroup PAC ID 3274010582, 129 clinicians

Practice addresses (Care Compare)

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501-3834
Phone (770) 533-6511

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.1 of 100Reported as group
Quality
87.6
Promoting interoperability
100
Improvement activities
40
Cost
76.07

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
6241KSMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Longstreet Clinic PC CurrentSince Nov 8, 2010 Accepting new patients
The Longstreet Clinic, PC Internal Medicine CurrentSince Nov 8, 2010 Accepting new patients
Northeast Georgia Community Physicians LLC Internal Medicine CurrentSince Feb 1, 2026 Accepting new patients

Locations

725 Jesse Jewell Pkwy SE
Gainesville, GA 30501
Phone (770) 297-2200

Interoperability endpoints

  • Direct secure messaging: fatimah.manzoor@longstreetclinic.gadirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311292800000",
    "number": "1750502357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 658",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305030658",
            "telephone_number": "770-718-1122",
            "fax_number": "770-535-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 JESSE JEWELL PKWY SE",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013834",
            "telephone_number": "770-535-0191",
            "fax_number": "770-535-0916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANZOOR",
        "first_name": "FATIMAH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-01",
        "last_updated": "2011-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "KS",
            "license": "6241",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "064600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "588865",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01401428",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00903602",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003100463A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1700011",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52497649",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

Verify at the official NPI Registry.