Basic Information
| Provider Information | |||||||||
| NPI: | 1235396722 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YASREBI | ||||||||
| FirstName: | MONA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 15TH ST STE BI-1056 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309123137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067218623 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 15TH ST STE BI-1056 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309120004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067218623 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 07/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 89660 | GA | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085N0700X | ME96588 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 308986 | LA | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085N0904X | C10011314 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085N0904X | ME96588 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | 89660 | GA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | ME96588 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | C10011314 | DE | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | MD456667 | PA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085P0229X | 308986 | LA | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | ME96588 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 308986 | LA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 89660 | GA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 89660 | 01 | GA | GA MEDICAL LICENSE | OTHER |