Healthcare Provider Details

I. General information

NPI: 1003738741
Provider Name (Legal Business Name): HARBORMED CARE OF GA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 WHITESIDE RD
MACON GA
31216-6209
US

IV. Provider business mailing address

3438 BELL BLVD STE 301
BAYSIDE NY
11361-1739
US

V. Phone/Fax

Practice location:
  • Phone: 478-347-2400
  • Fax:
Mailing address:
  • Phone: 718-709-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PEYMAN E YOUNESI
Title or Position: OWNER
Credential: MD
Phone: 718-709-0940