Provider Demographics
NPI:1114589264
Name:MANSARAY, RAHAMAT (MD)
Entity Type:Individual
Prefix:
First Name:RAHAMAT
Middle Name:
Last Name:MANSARAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAHAMAT
Other - Middle Name:
Other - Last Name:ODUNSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:859 MOUNT VERNON HWY NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4255
Mailing Address - Country:US
Mailing Address - Phone:404-785-0588
Mailing Address - Fax:
Practice Address - Street 1:859 MOUNT VERNON HWY NE STE 300
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4255
Practice Address - Country:US
Practice Address - Phone:404-785-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351045668208000000X
GA978092080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics