Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 83659 | GA |
NPI | 1366862203 |
---|---|
Provider Name | Parisa Mansoori |
First Address | Brentwood, TN 37027-7542 |
Second Address | Atlanta, GA 30349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2014 |
Last Update Date | 23/07/2019 |