Healthcare Provider Details

I. General information

NPI: 1649382060
Provider Name (Legal Business Name): MOUNIR DARRADJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 WINDING RIDGE CT
ATLANTA GA
30338-3949
US

IV. Provider business mailing address

1019 WINDING RIDGE CT
ATLANTA GA
30338-3949
US

V. Phone/Fax

Practice location:
  • Phone: 770-888-2524
  • Fax:
Mailing address:
  • Phone: 770-888-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number48998
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: