Healthcare Provider Details

I. General information

NPI: 1861938383
Provider Name (Legal Business Name): AMIR FARZAD ABDOLY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 SHRINE RD STE 290
BRUNSWICK GA
31520-4785
US

IV. Provider business mailing address

PO BOX 1213
BRUNSWICK GA
31521-1213
US

V. Phone/Fax

Practice location:
  • Phone: 912-466-7660
  • Fax: 912-264-1526
Mailing address:
  • Phone: 912-466-5000
  • Fax: 912-466-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS15678
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number103910
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: