Healthcare Provider Details

I. General information

NPI: 1013536549
Provider Name (Legal Business Name): POURIA HOSSEINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2020
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOE FRANK HARRIS PKWY SE
CARTERSVILLE GA
30120-2129
US

IV. Provider business mailing address

2842 EVA LEE CT NE
MARIETTA GA
30062-6682
US

V. Phone/Fax

Practice location:
  • Phone: 470-490-2142
  • Fax:
Mailing address:
  • Phone: 404-661-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95668
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number95668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: