MEDICARE: DR. MARIAM FATEHI PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW009940	GA

General Provider Information

NPI Number	:	1467305037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIAM FATEHI PHD

Provider Business Mailing Address
First Line	:	PO BOX 566843
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31156-6843
Country	:	US
Telephone Number	:	404-234-8434
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 SUMMERSET LN
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-1659
Country	:	US
Telephone Number	:	404-234-8434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/16/2026
Last Update Date	:	02/16/2026

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