Basic Information
| Provider Information | |||||||||
| NPI: | 1003187709 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DINI | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | MAHSA | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1835 SAVOY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042230792 | ||||||||
| FaxNumber: | 4042235815 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 PEACHTREE ST NE STE 1185 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303082236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042230792 | ||||||||
| FaxNumber: | 4042235815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2012 | ||||||||
| LastUpdateDate: | 08/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 006378 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 003122889B | 05 | GA | MEDICAID | 003122889C | 05 | GA | MEDICAID | 202I972744 | 01 | GA | MEDICARE PTAN | OTHER |