Healthcare Provider Details

I. General information

NPI: 1821674698
Provider Name (Legal Business Name): SINA HEDAYATPOUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 N DECATUR RD
DECATUR GA
30033-5918
US

IV. Provider business mailing address

800 STANTON L YOUNG BLVD
OKLAHOMA CITY OK
73104-5018
US

V. Phone/Fax

Practice location:
  • Phone: 404-501-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number9507
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number103717
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV6027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: