Provider Demographics
NPI:1508557208
Name:MANSOUR, AYA HASEEB (PA)
Entity Type:Individual
Prefix:
First Name:AYA
Middle Name:HASEEB
Last Name:MANSOUR
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1114 SUNNY FIELD LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-6703
Mailing Address - Country:US
Mailing Address - Phone:678-266-7445
Mailing Address - Fax:
Practice Address - Street 1:340 KENNESTONE HOSPITAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1158
Practice Address - Country:US
Practice Address - Phone:770-281-5100
Practice Address - Fax:678-581-7100
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-09-25
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant