Basic Information
| Provider Information | |||||||||
| NPI: | 1467715540 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | ABRAR | ||||||||
| MiddleName: | ADIL | ||||||||
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| Credential: | D.O. | ||||||||
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| OtherLastName: | ADIL | ||||||||
| OtherFirstName: | ABRAR | ||||||||
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| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 117265 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303687265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | |||||||||
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| Practice Location | |||||||||
| Address1: | 1305 JENNINGS MILL RD STE 110 | ||||||||
| Address2: | |||||||||
| City: | WATKINSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306777241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066135880 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 5344 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0801X | 5344 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 86481 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.