Healthcare Provider Details

I. General information

NPI: 1780893073
Provider Name (Legal Business Name): MEHRDAD SEILANIAN TOOSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MEHRDAD TOOSI MD

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W PEACHTREE ST NW STE 920
ATLANTA GA
30309-3609
US

IV. Provider business mailing address

1110 W PEACHTREE ST NW STE 920
ATLANTA GA
30309-3609
US

V. Phone/Fax

Practice location:
  • Phone: 404-962-6000
  • Fax: 404-962-6001
Mailing address:
  • Phone: 404-960-6000
  • Fax: 404-962-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number067089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: