1568420081 NPI number — DR. SYED TANVIR RAHMAN M.D.

Table of content: DR. SYED TANVIR RAHMAN M.D. (NPI 1568420081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568420081 NPI number — DR. SYED TANVIR RAHMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMAN
Provider First Name:
SYED
Provider Middle Name:
TANVIR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568420081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1222 STATE ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30318-5334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-885-9947
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5673 PEACHTREE DUNWOODY RD NE
Provider Second Line Business Practice Location Address:
SUITE 440
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-296-1130
Provider Business Practice Location Address Fax Number:
404-296-1132
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  047506 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000836481E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00836481D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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