Healthcare Provider Details

I. General information

NPI: 1093526063
Provider Name (Legal Business Name): SIAVASH GHANEAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 DAVIS DR
ALPHARETTA GA
30009-4746
US

IV. Provider business mailing address

10600 DAVIS DR
ALPHARETTA GA
30009-4746
US

V. Phone/Fax

Practice location:
  • Phone: 404-578-4767
  • Fax:
Mailing address:
  • Phone: 404-578-4767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS001105
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: