MEDICARE: MICHAEL MIRZABEIGI MD

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	208200000X	Plastic Surgery Physician	080945	GA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	080945	GA

General Provider Information

NPI Number	:	1366703258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MIRZABEIGI MD

Provider Business Mailing Address
First Line	:	975 JOHNSON FY RD NE STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1618
Country	:	US
Telephone Number	:	404-256-1311
Fax Number	:	404-705-2774

Provider Business Practice Location Address
First Line	:	975 JOHNSON FY RD NE STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1618
Country	:	US
Telephone Number	:	404-256-1311
Fax Number	:	404-250-3377

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	01/14/2025

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