Provider Demographics
NPI:1154950509
Name:MANSOORI, ARIA (DPM)
Entity type:Individual
Prefix:
First Name:ARIA
Middle Name:
Last Name:MANSOORI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4101 CHARLOTTE AVE STE F185
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4066
Mailing Address - Country:US
Mailing Address - Phone:615-612-0122
Mailing Address - Fax:
Practice Address - Street 1:3655 HOWELL FERRY RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3186
Practice Address - Country:US
Practice Address - Phone:770-497-8283
Practice Address - Fax:770-497-8285
Is Sole Proprietor?:No
Enumeration Date:2020-04-07
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001545213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery