Mahnoor Azhar
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Braselton, GA
NPI 1831983535 · NPPES record last updated Apr 7, 2025
Key facts
- NPI
- 1831983535
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1515 River PL Ste 200
Braselton, GA 30517-5603 - Phone
- (770) 848-6140
- Fax
- (770) 848-6141
- NPI assigned
- Apr 7, 2025
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250801002713 | GA | Order and Referring Only - Internal Medicine |
2365950227 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | GA | Yes |
Addresses
Primary practice location
1515 River PL Ste 200
Braselton, GA 30517-5603
Mailing address
743 Spring Street
Suite 710
Gainesville, GA 30501
Phone (770) 219-8730
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- Daniel E Ault
- Crystal Vanesa Ayazo
- Jennifer Song Badaracco
- Ashley Banks
- Allen Barbarovich
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All providers in Braselton, GA · Student in an Organized Health Care Education/Training Program in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 7, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.