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NPI Code Detail

MEDICARE: MUSHAIRAT MAMUN PA

MEDICARE: MUSHAIRAT MAMUN PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1295423143
Entity Type Code : Individual
Provider Name (Legal Business Name) : MUSHAIRAT MAMUN PA
Provider Business Mailing Address
First Line : 1121 JOHNSON FERRY RD STE 450
Second Line :
City : MARIETTA
State : GA
Zip : 30068-5433
Country : US
Telephone Number : 770-694-6349
Fax Number :
Provider Business Practice Location Address
First Line : 1121 JOHNSON FERRY RD STE 450
Second Line :
City : MARIETTA
State : GA
Zip : 30068-5433
Country : US
Telephone Number : 770-694-6349
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2023
Last Update Date : 09/18/2025

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Directions to “ MUSHAIRAT MAMUN PA” Practice Location

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