DR. AZAD MANSOURI (NPI# 1477744068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477744068 |
| Entity Type | Individual |
| Full Name | DR. AZAD MANSOURI |
| Credential | MD |
| Practice Address |
2400 Mt. Zion Parkway Kaiser Permanente Southwood Medical Center Jonesboro GA 30236 |
| Mailing Address |
3495 Piedmont Road, Ne Nine Piedmont Center Atlanta GA 30305 |
| Practice Telephone | 4103374500 |
| Practice Fax Number | 4103397326 |
| Mailing Telephone | 4045045678 |
| Mailing Fax Number | 4103397326 |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2016-11-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | 076153 | GA | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | 0101247198 | VA | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | D70402 | MD | Allopathic & Osteopathic Physicians |
| N | 207W00000X | Ophthalmology | 2006017512 | MO | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 033505300 | 05 | |
| DC | 078242200 | 05 | |
| VA | 1477744068 | 05 |
| Street Address |
2400 MT. ZION PARKWAY KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER |
| City | JONESBORO |
| State | GA |
| Zip Code | 30236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508866153 | Jodi Bayley Baptiste | Family Medicine | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2005-07-26 |
| 1013450816 | Dorothy Delisfort-crisostomo | Nurse Practitioner | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehension Medical Offic, Jonesboro, GA 30236 | 2016-11-28 |
| 1639590136 | Ashley Christine Ziobrowski | Nurse Practitioner | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2013-12-31 |
| 1730520321 | Nash Ditmetaroj | Optometrist | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2013-07-10 |
| 1770927402 | Labrittany R Davis-farve | Nurse Practitioner | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2013-04-24 |
| 1477896645 | Fofie S Akoto | Internal Medicine | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2013-04-05 |
| 1265773584 | Karen Kelly Willard | Nurse Practitioner | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2013-03-12 |
| 1114264652 | Jaclyn Marie Schwartz | Podiatrist | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2013-01-03 |
| 1801144605 | Dorie Angela Saxon | Pediatrics | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2012-08-28 |
| 1689937880 | Meena Yasmeen | Family Medicine | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Comprehensive Medical Cente, Jonesboro, GA 30236 | 2012-06-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972123362 | Life Source Counseling & Consulting, LLC | Clinic/Center | 118 North Avenue, Suite A, Jonesboro, GA 30236 | 2020-04-25 |
| 1639609555 | New Beginnings Behavioral Counseling,llc | Social Worker | 9456 S Main St Ste E2, Jonesboro, GA 30236 | 2017-06-13 |
| 1437696762 | Clarissa Alexandra Poole | Counselor | 2106 Fair Ridge Ct, Jonesboro, GA 30236 | 2017-01-25 |
| 1588012892 | Sundance Healthcare Service Inc | In Home Supportive Care | 7861 Collinswood Court, Jonesboro, GA 30236 | 2016-05-26 |
| 1942669205 | Adrianne Smiley Gurley | Occupational Therapist | 1299 Battlecreek Rd Ste 210, Jonesboro, GA 30236 | 2016-02-15 |
| 1336505809 | Integrated Health Center | Dentist | 8600 Tara Blvd, Suite D, Jonesboro, GA 30236 | 2016-01-13 |
| 1467827402 | Surrell Porter | Nurse Practitioner | 1287 Georgia Highway 138 Spur, Suite 8, Jonesboro, GA 30236 | 2015-12-02 |
| 1740688910 | Jacqueline Carolyn Edwards | Registered Nurse | 8081 Tara Blvd, 265, Jonesboro, GA 30236 | 2014-12-19 |
| 1770991861 | Lower Extremity Diagnostics, LLC | Podiatrist | 6911 Tara Boulevard, Jonesboro, GA 30236 | 2014-08-01 |
| 1760899710 | Fresenius Medical Care Jonesboro, LLC | Clinic/Center | 8060 Summitt Business Parkway, Jonesboro, GA 30236 | 2014-07-22 |
| Find all providers in zip 30236 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861428534 | Mid-south Retina Associates, LLC | Ophthalmology | 820 E Matthews Ave, Suite E, Jonesboro, AR 72401-3048 | 2006-06-24 |
| 1972569036 | Matthew W Margolis | Ophthalmology | 601 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-04-25 |
| 1205064441 | Anjum Sharif Cheema | Ophthalmology | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2009-06-25 |
| 1003077033 | Emily King Deschler | Ophthalmology | 2400 Mt. Zion Parkway, Kruiser Permanente Southwood Medical Center, Jonesboro, GA 36236 | 2008-06-23 |
| 1487824272 | Prathima Thumma Warrier | Ophthalmology | 2400 Mt. Zion Parkway, Kaiser Permanente Southwood Medical Center, Jonesboro, GA 30236 | 2008-03-07 |
| 1417098153 | Thomas L Nix | Ophthalmology | 623 E Matthews Ave, Jonesboro, AR 72401-3145 | 2007-02-08 |
| 1598779209 | Thomas M Stank | Ophthalmology | 601 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-07-28 |
| 1215968425 | Russell Lee Harral IIi | Ophthalmology | 623 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-07-05 |
| 1730110958 | Joseph Charles Stainton | Ophthalmology | 623 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-07-05 |
| 1447288097 | Vision Care Center of Northeast Arkansas LLC | Ophthalmology | 623 E Matthews Ave, Jonesboro, AR 72401-3145 | 2006-06-30 |
| Find all providers in JONESBORO | ||||
Please comment or provide details below to improve the information on DR. AZAD MANSOURI.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.