Healthcare Provider Details

I. General information

NPI: 1720028517
Provider Name (Legal Business Name): DARIUSH HEIDARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 WATERS AVE SUITE 452
SAVANNAH GA
31404-6200
US

IV. Provider business mailing address

4750 WATERS AVE SUITE 452
SAVANNAH GA
31404-6200
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-7188
  • Fax: 912-354-5208
Mailing address:
  • Phone: 912-354-7188
  • Fax: 912-354-5208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number018668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: