Provider Demographics
NPI:1063457059
Name:RAZAVI, AMIR BEHZAD (MD)
Entity Type:Individual
Prefix:
First Name:AMIR BEHZAD
Middle Name:
Last Name:RAZAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEHZAD
Other - Middle Name:
Other - Last Name:RAZAVI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:601 S 8TH ST
Mailing Address - Street 2:P. O. DRAWER V
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4213
Mailing Address - Country:US
Mailing Address - Phone:770-467-6104
Mailing Address - Fax:678-583-0261
Practice Address - Street 1:1418 BAYTOWNE CIR E
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-4890
Practice Address - Country:US
Practice Address - Phone:850-830-9452
Practice Address - Fax:678-583-0261
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51539207R00000X, 207RI0200X
FLME113682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000953147BMedicaid
AL009993180Medicaid
GA52893951-003OtherBLUE CROSS/BLUE SHIELD
AL009993180Medicaid
GA000953147BMedicaid