Healthcare Provider Details

I. General information

NPI: 1871427641
Provider Name (Legal Business Name): FARIBA SOHRABI DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 E PONCE DE LEON AVE STE A
CLARKSTON GA
30021-1839
US

IV. Provider business mailing address

1909 ENFIELD CT
CONYERS GA
30013-7417
US

V. Phone/Fax

Practice location:
  • Phone: 801-200-2872
  • Fax:
Mailing address:
  • Phone: 801-200-2872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP315548
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: