MEDICARE: DR. SAMAD HONARVAR M.D.

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	174400000X	Specialist	MD0000041519	TN
2	207Y00000X	Otolaryngology Physician	016361	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	203446262	OTHER	TN	BEECH STREET
2	203446262	OTHER	TN	PHP
3	203446262	OTHER	TN	HUMANA
4	203446262	OTHER	TN	TRI CARE
5	473931	OTHER	GA	AETNA
6	203446262	OTHER	TN	AMERIGROUP
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	203446262	OTHER	TN	TENNCARE
10	6390202	OTHER	GA	CIGNA
11	6390202	OTHER	TN	CIGNA
12	203446262	OTHER	TN	PERDUE
13	203446262	OTHER	TN	AETNA
14	4135659	OTHER	TN	BLUE CROSS BLUE SHIELD
15	203446262	OTHER	TN	AMERICHOICE
16	203446262	OTHER	TN	UNITED HEALTH CARE
17	52238357	OTHER	GA	BCBS OF GEORGIA
18	943882	OTHER	TN	PHS

General Provider Information

NPI Number	:	1386636918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMAD HONARVAR M.D.

Provider Business Mailing Address
First Line	:	925 N POINT PKWY
Second Line	:	STE 130
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-5210
Country	:	US
Telephone Number	:	678-206-2589
Fax Number	:	678-261-1713

Provider Business Practice Location Address
First Line	:	1995 N PARK PL SE
Second Line	:	STE 550
City	:	ATLANTA
State	:	GA
Zip	:	30339-7801
Country	:	US
Telephone Number	:	770-438-6318
Fax Number	:	770-438-2185

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/02/2016

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