Healthcare Provider Details

I. General information

NPI: 1578584421
Provider Name (Legal Business Name): PARVIZ BRAHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 TIFT AVE N STE D
TIFTON GA
31794-3579
US

IV. Provider business mailing address

1805 TIFT AVE N STE D
TIFTON GA
31794-3579
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-5554
  • Fax: 229-382-0530
Mailing address:
  • Phone: 229-382-5554
  • Fax: 229-382-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME64510
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number66576
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: