Healthcare Provider Details

I. General information

NPI: 1063412567
Provider Name (Legal Business Name): AARON R ALIZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 LAWRENCEVILLE HWY
DECATUR GA
30033-2512
US

IV. Provider business mailing address

1835 SAVOY DR SUITE 300
ATLANTA GA
30341-1072
US

V. Phone/Fax

Practice location:
  • Phone: 770-496-5555
  • Fax: 770-939-2887
Mailing address:
  • Phone: 770-495-3396
  • Fax: 770-495-2307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number046027
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: