Provider Demographics
NPI:1316388762
Name:SAMANDARI, TARAZ (MD PHD)
Entity Type:Individual
Prefix:
First Name:TARAZ
Middle Name:
Last Name:SAMANDARI
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E PHARR RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4426
Mailing Address - Country:US
Mailing Address - Phone:404-704-0976
Mailing Address - Fax:
Practice Address - Street 1:1600 CLIFTON RD NE
Practice Address - Street 2:MAILSTOP E-45
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4018
Practice Address - Country:US
Practice Address - Phone:404-639-1676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051447207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease