Healthcare Provider Details

I. General information

NPI: 1780984658
Provider Name (Legal Business Name): AMIR H ARYAIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 UPPER HEMBREE RD STE A
ROSWELL GA
30076-0912
US

IV. Provider business mailing address

1105 UPPER HEMBREE RD STE A
ROSWELL GA
30076-0912
US

V. Phone/Fax

Practice location:
  • Phone: 678-626-0909
  • Fax:
Mailing address:
  • Phone: 404-512-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.018576
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number75376
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.125225
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: