Healthcare Provider Details

I. General information

NPI: 1255731741
Provider Name (Legal Business Name): JAFAR TABATABAI M.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7961 HIGHWAY 92 STE 100
WOODSTOCK GA
30189-5209
US

IV. Provider business mailing address

1037 THIRD ST
STONE MOUNTAIN GA
30083-3025
US

V. Phone/Fax

Practice location:
  • Phone: 770-627-2434
  • Fax: 770-627-5347
Mailing address:
  • Phone: 770-469-8874
  • Fax: 770-879-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number14868
License Number StateGA

VIII. Authorized Official

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