Healthcare Provider Details

I. General information

NPI: 1750709770
Provider Name (Legal Business Name): PAUL PEDRAM DARAEI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PRESTON RIDGE RD STE 380
ALPHARETTA GA
30005-4596
US

IV. Provider business mailing address

304 MEADOWBROOK DR
ATLANTA GA
30342-3312
US

V. Phone/Fax

Practice location:
  • Phone: 678-208-6008
  • Fax:
Mailing address:
  • Phone: 949-232-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number7169
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number37848
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number84724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: