Provider Demographics
NPI:1225150105
Name:RASSOULI, NEGAH (MD)
Entity Type:Individual
Prefix:
First Name:NEGAH
Middle Name:
Last Name:RASSOULI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CUMBERLAND PKWY SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3915
Mailing Address - Country:US
Mailing Address - Phone:770-431-4186
Mailing Address - Fax:770-431-4186
Practice Address - Street 1:2525 CUMBERLAND PKWY SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3915
Practice Address - Country:US
Practice Address - Phone:770-431-4186
Practice Address - Fax:770-431-4186
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058495174400000X
GA58495207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist