Healthcare Provider Details

I. General information

NPI: 1710805189
Provider Name (Legal Business Name): MANSI VERMA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 E 15TH AVE
CORDELE GA
31015-1439
US

IV. Provider business mailing address

1072 HEATHCHASE DR
SUWANEE GA
30024-3623
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-5753
  • Fax:
Mailing address:
  • Phone: 404-428-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN124227
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: