Provider Demographics
NPI:1386636918
Name:HONARVAR, SAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAD
Middle Name:
Last Name:HONARVAR
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 1:925 N POINT PKWY
Mailing Address - Street 2:STE 130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5210
Mailing Address - Country:US
Mailing Address - Phone:678-206-2589
Mailing Address - Fax:678-261-1713
Practice Address - Street 1:1995 N PARK PL SE
Practice Address - Street 2:STE 550
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-7801
Practice Address - Country:US
Practice Address - Phone:770-438-6318
Practice Address - Fax:770-438-2185
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000041519174400000X
GA016361207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN203446262OtherBEECH STREET
TN203446262OtherPHP
TN203446262OtherHUMANA
TN203446262OtherTRI CARE
GA473931OtherAETNA
TN203446262OtherAMERIGROUP
TN3823664Medicaid
GA000181761CMedicaid
TN203446262OtherTENNCARE
GA6390202OtherCIGNA
TN6390202OtherCIGNA
TN203446262OtherPERDUE
TN203446262OtherAETNA
TN4135659OtherBLUE CROSS BLUE SHIELD
TN203446262OtherAMERICHOICE
TN203446262OtherUNITED HEALTH CARE
GA52238357OtherBCBS OF GEORGIA
TN943882OtherPHS
TN203446262OtherAMERIGROUP
TN203446262OtherPHP