Active NPI
Azita Agharahimi Mansouri, D.M.D.
- Dentist
- Lawrenceville, GA
National Provider Identifier
1821288226
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN013537
- Practice address
- 2401 Lawrenceville Hwy
Suite a
Lawrenceville, GA 30044-4411 - Phone
- (770) 962-1977
- Fax
- (770) 962-9886
- NPI assigned
- Jul 31, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN013537 | GA | Primary |
Addresses
Primary practice location
2401 Lawrenceville Hwy
Suite a
Lawrenceville, GA 30044-4411
Mailing address
2401 Lawrenceville Hwy
Suite a
Lawrenceville, GA 30044-4411
Phone (770) 962-1977
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 |
|---|---|---|---|
| DN013537 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185840000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213747200000",
"number": "1821288226",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 LAWRENCEVILLE HWY",
"address_2": "SUITE A",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300444411",
"telephone_number": "770-962-1977",
"fax_number": "770-962-9886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2401 LAWRENCEVILLE HWY",
"address_2": "SUITE A",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300444411",
"telephone_number": "770-962-1977",
"fax_number": "770-962-9886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANSOURI",
"first_name": "AZITA",
"middle_name": "AGHARAHIMI",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-31",
"last_updated": "2008-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN013537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 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.