Healthcare Provider Details

I. General information

NPI: 1942943006
Provider Name (Legal Business Name): AIDA GHOLAMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

IV. Provider business mailing address

600 CELEBRATE LIFE PKWY
NEWNAN GA
30265-8001
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-6000
  • Fax:
Mailing address:
  • Phone: 770-400-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberA199098
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number110135
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: