Healthcare Provider Details

I. General information

NPI: 1427624337
Provider Name (Legal Business Name): FABIAN ANDRES ALTAMIRANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 S 8TH ST STE 100
GRIFFIN GA
30224-4260
US

IV. Provider business mailing address

619 S 8TH ST
GRIFFIN GA
30224-4260
US

V. Phone/Fax

Practice location:
  • Phone: 678-248-2899
  • Fax: 770-233-4824
Mailing address:
  • Phone: 678-248-2899
  • Fax: 770-233-4824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number111175
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: