MEDICARE: DR. RATA ROKHSHAD

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	390200000X	Student in an Organized Health Care Education/Training Program		CA

General Provider Information

NPI Number	:	1942131057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RATA ROKHSHAD

Provider Business Mailing Address
First Line	:	3229 WISTERIA CIR VESTAVIA HILLS
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-4292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 TAZEWELL PIKE STE 6A
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-1880
Country	:	US
Telephone Number	:	617-319-3955
Fax Number	:

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

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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