Healthcare Provider Details

I. General information

NPI: 1275712606
Provider Name (Legal Business Name): JAFAR TABATABI, M.D, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 THIRD ST
STONE MTN GA
30083-3025
US

IV. Provider business mailing address

1037 THIRD ST
STONE MTN GA
30083-3025
US

V. Phone/Fax

Practice location:
  • Phone: 770-469-8874
  • Fax: 770-879-0317
Mailing address:
  • Phone: 770-469-8874
  • Fax: 770-879-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014868
License Number StateGA

VIII. Authorized Official

Name: DR. JAFAR TABATABAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 770-469-8874