Healthcare Provider Details

I. General information

NPI: 1437205481
Provider Name (Legal Business Name): JEFFREY HAMPAR MINASSIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PHARR RD SUITE 575
ATLANTA GA
30305
US

IV. Provider business mailing address

1147 SPRINGDALE RD
ATLANTA GA
30306
US

V. Phone/Fax

Practice location:
  • Phone: 404-231-0930
  • Fax: 404-261-5107
Mailing address:
  • Phone: 404-231-0930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number22601
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: