Healthcare Provider Details

I. General information

NPI: 1326427642
Provider Name (Legal Business Name): SHAYAN GREG ZAFRANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 HEMLOCK ST MSC 143
MACON GA
31201-2102
US

IV. Provider business mailing address

777 HEMLOCK ST MSC 143
MACON GA
31201-2102
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-5550
  • Fax: 478-784-3550
Mailing address:
  • Phone: 478-633-5550
  • Fax: 478-784-3550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number007718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: