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General NPI Number Information
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NPI Number | 1508043944
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Entity Type | Individual
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Provider Name | ANAHID A EBRAHIMI PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 144 BILL CARRUTH PKWY SUITE 3600
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City | HIRAM
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State | GA
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Zip | 30141
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Country | US
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Telephone | 678-486-5500
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Fax | 678-486-5502
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Provider Business Mailing Address
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Address Line | 1355 PEACHTREE ST NE SUITE 1600
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City | ATLANTA
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State | GA
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Zip | 30309-3212
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Country | US
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Telephone | 678-486-5500
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Fax | 678-486-5502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002651
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License Number State | GA
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