Healthcare Provider Details

I. General information

NPI: 1194396309
Provider Name (Legal Business Name): MAHSA KATHERINE MASOUDI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD STE 300
ATLANTA GA
30342-1718
US

IV. Provider business mailing address

3967 CHAPEL GROVE DR
MARIETTA GA
30062-1067
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT003344
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT003344
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: