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General NPI Number Information
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NPI Number | 1366621237
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTA NEUROSURGERY
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 08/19/2013
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Provider Practice Location Address
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Address Line | 900 EAGLES LANDING PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 770-997-0600
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Fax |
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Provider Business Mailing Address
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Address Line | 900 EAGLES LANDING PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 770-997-0600
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | SHAHRAM REZAIAMIRI
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Credential | M.D.
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Telephone | 770-997-0600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 049939
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License Number State | GA
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