Healthcare Provider Details

I. General information

NPI: 1780004705
Provider Name (Legal Business Name): ARASH TAHERI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 RALPH DAVID ABERNATHY BLVD SW
ATLANTA GA
30310-1649
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 404-836-0136
  • Fax: 404-753-5266
Mailing address:
  • Phone: 404-836-0136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017-01927
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83724
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: