Healthcare Provider Details

I. General information

NPI: 1366862203
Provider Name (Legal Business Name): PARISA MANSOORI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PHOENIX BLVD STE 210
ATLANTA GA
30349
US

IV. Provider business mailing address

1010 AIRPARK CENTER DR
NASHVILLE TN
37217-5200
US

V. Phone/Fax

Practice location:
  • Phone: 615-221-4400
  • Fax:
Mailing address:
  • Phone: 615-221-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number83659
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number59999
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: