Healthcare Provider Details

I. General information

NPI: 1386273175
Provider Name (Legal Business Name): MEHRNOOSH GHANDILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 PANTHERSVILLE RD
DECATUR GA
30034-3830
US

IV. Provider business mailing address

3121 PANTHERSVILLE RD
DECATUR GA
30034-3830
US

V. Phone/Fax

Practice location:
  • Phone: 404-270-8210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number113624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: