Healthcare Provider Details

I. General information

NPI: 1386636918
Provider Name (Legal Business Name): SAMAD HONARVAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 N PARK PL SE STE 550
ATLANTA GA
30339-7801
US

IV. Provider business mailing address

925 N POINT PKWY STE 130
ALPHARETTA GA
30005-5210
US

V. Phone/Fax

Practice location:
  • Phone: 770-438-6318
  • Fax: 770-438-2185
Mailing address:
  • Phone: 678-206-2589
  • Fax: 678-261-1713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD0000041519
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number016361
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: