Healthcare Provider Details

I. General information

NPI: 1720424898
Provider Name (Legal Business Name): ASMA MOUSSAOUI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 INTERSTATE NORTH CIR SE STE 600
ATLANTA GA
30339-2454
US

IV. Provider business mailing address

280 INTERSTATE NORTH CIR SE STE 600
ATLANTA GA
30339-2454
US

V. Phone/Fax

Practice location:
  • Phone: 612-385-9727
  • Fax:
Mailing address:
  • Phone: 612-385-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number159996
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberD0103068
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME157526
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036.143379
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number35C.000750
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101279797
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number13388
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME157526
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number036.143379
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: