1386636918 NPI number — DR. SAMAD HONARVAR M.D.

Table of content: DR. SAMAD HONARVAR M.D. (NPI 1386636918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386636918 NPI number — DR. SAMAD HONARVAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HONARVAR
Provider First Name:
SAMAD
Provider Middle Name:
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:
1386636918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 N POINT PKWY
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
ALPHARETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30005-5210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-206-2589
Provider Business Mailing Address Fax Number:
678-261-1713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1995 N PARK PL SE
Provider Second Line Business Practice Location Address:
STE 550
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30339-7801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-438-6318
Provider Business Practice Location Address Fax Number:
770-438-2185
Provider Enumeration Date:
08/19/2005

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: 174400000X , with the licence number:  MD0000041519 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 016361 , 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: 203446262 . This is a "BEECH STREET" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "PHP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "HUMANA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "TRI CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 473931 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "AMERIGROUP" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3823664 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000181761C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203446262 . This is a "TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 6390202 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 6390202 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "PERDUE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4135659 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "AMERICHOICE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 203446262 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 52238357 . This is a "BCBS OF GEORGIA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 943882 . This is a "PHS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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