Healthcare Provider Details

I. General information

NPI: 1417698606
Provider Name (Legal Business Name): MEHRNOOSH SAMAEI MD,MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

2 REGENCY PLZ APT 503
PROVIDENCE RI
02903-3146
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8865
  • Fax:
Mailing address:
  • Phone: 401-699-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number14454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: