Healthcare Provider Details

I. General information

NPI: 1598104549
Provider Name (Legal Business Name): NATALIE ROUKHSANEH GARCIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE ROUKHSANEH SABZGHABAEI MD

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

2484 ELLIJAY DR NE
BROOKHAVEN GA
30319-3440
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 940-231-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301103969
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: