Provider Demographics
NPI:1346446747
Name:FIROUZTALE, PEJMAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:PEJMAN
Middle Name:A
Last Name:FIROUZTALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 PIEDMONT RD NE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1609
Mailing Address - Country:US
Mailing Address - Phone:404-870-2802
Mailing Address - Fax:404-419-6623
Practice Address - Street 1:3520 PIEDMONT RD NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1609
Practice Address - Country:US
Practice Address - Phone:404-870-2802
Practice Address - Fax:404-419-6623
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004014330390200000X
CAA1041152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program