Healthcare Provider Details

I. General information

NPI: 1609096585
Provider Name (Legal Business Name): HOUMAN TAMADDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HOUMAN TAMADDON M.D.

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 WALTON WAY
AUGUSTA GA
30901-2612
US

IV. Provider business mailing address

PO BOX 1705
AUGUSTA GA
30903-1705
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-7022
  • Fax: 706-774-7023
Mailing address:
  • Phone: 706-774-7263
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number91547
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number63032
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: