Individual ProviderFatimah ManzoorInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address725 Jesse Jewell Pkwy SE, Gainesville, GA 30501-3834(770) 535-0191(770) 718-1122PECOS EnrollmentBased on the most recent information from CMS, provider Fatimah Manzoor is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1750502357Provider TypeIndividualFull NameManzoor, FatimahCredentialMDGenderFemaleSole ProprietorNoEnumeration Date5/1/2007Last Updated7/22/2011Contact InformationPractice LocationPractice Address725 Jesse Jewell Pkwy SE, Gainesville, GA 30501-3834Phone(770) 535-0191Fax(770) 535-0916Mailing LocationMailing AddressPO Box 658, Gainesville, GA 30503-0658Phone(770) 718-1122Fax(770) 535-7445Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense064600GeorgiaCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense6241KansasProvider IdentifiersIDDescriptionIssuerID588865DescriptionOtherIssuerWELLCAREGeorgiaID01401428DescriptionOtherIssuerAMERIGROUPGeorgiaIDP00903602DescriptionOtherIssuerMEDICARE RAILROADGeorgiaID003100463ADescriptionMedicaidIssuerUnlistedGeorgiaID1700011DescriptionOtherIssuerCIGNAGeorgiaID52497649DescriptionOtherIssuerBCBSGeorgia