1780910737 NPI number — FARAANAK MOBINI PA-S

Table of content: FARAANAK MOBINI PA-S (NPI 1780910737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780910737 NPI number — FARAANAK MOBINI PA-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOBINI
Provider First Name:
FARAANAK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOBINI
Provider Other First Name:
FARAA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1780910737
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 JOHNSON FERRY RD NE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-1631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-943-0900
Provider Business Mailing Address Fax Number:
404-943-1390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
275 COLLIER RD NW STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30309-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-350-0009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2009

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: 363AM0700X , with the licence number:  005549 , 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)