Healthcare Provider Details

I. General information

NPI: 1134744089
Provider Name (Legal Business Name): SIAMAK HEJABIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

674 OAKSIDE PL
ACWORTH GA
30102-8800
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-3818
  • Fax:
Mailing address:
  • Phone: 404-727-3818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4351046564
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number14645
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: