Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 080136 | GA |
NPI | 1699109579 |
---|---|
Provider Name | Mr. Asifhusen Abdulrahim Mansuri |
First Address | Augusta, GA 30901-2603 |
Second Address | Augusta, GA 30912-7701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2013 |
Last Update Date | 07/05/2018 |