Provider Demographics
NPI:1689409088
Name:LUCKHURST, MAISOON SAID (FNP-C)
Entity type:Individual
Prefix:
First Name:MAISOON
Middle Name:SAID
Last Name:LUCKHURST
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MAISOON
Other - Middle Name:AYOUB
Other - Last Name:SAID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:2435 RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30360-2509
Mailing Address - Country:US
Mailing Address - Phone:770-866-7194
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 1060
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2251
Practice Address - Country:US
Practice Address - Phone:404-778-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269954363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily