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DR. AZAD MANSOURI MD NPI 1477744068


NPI Information

NPI: 1477744068
Provider Name: DR. AZAD MANSOURI, MD
Classification: Ophthalmology - 207W00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
2400 MOUNT ZION PKWY
KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
JONESBORO, GA
ZIP 30236
Phone: (410) 337-4500
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DR. Azad Mansouri, MD is an ophthalmology in Jonesboro, GA with 18 years of experience. The provider is an ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. DR. Azad Mansouri, MD NPI is 1477744068. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2006

The provider's business location address is:

2400 MOUNT ZION PKWY
KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
JONESBORO, GA
ZIP 30236-500
Phone: (410) 337-4500
Fax: (410) 339-7326

The NPI 1477744068 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/7/2007 and was last updated on 1/10/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207W00000XOphthalmology0101247198VIRGINIANo
2207W00000XOphthalmologyD70402MARYLANDNo
3207W00000XOphthalmology2006017512MISSOURINo
4207W00000XOphthalmology076153GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1078242200MEDICAIDDISTRICT OF COLUMBIA
21477744068MEDICAIDVIRGINIA
3033505300MEDICAIDMARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.