MEDICARE: SHIDEH HAJI SEYED JAVADI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	34.018133	OH

General Provider Information

NPI Number	:	1154023349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIDEH HAJI SEYED JAVADI

Provider Business Mailing Address
First Line	:	10605 HIGHGATE MANOR CT
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4432
Country	:	US
Telephone Number	:	678-687-1100
Fax Number	:

Provider Business Practice Location Address
First Line	:	10605 HIGHGATE MANOR CT
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4432
Country	:	US
Telephone Number	:	678-687-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	12/03/2025

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