Provider Demographics
NPI:1508043944
Name:EBRAHIMI, ANAHID A (PA-C)
Entity Type:Individual
Prefix:
First Name:ANAHID
Middle Name:A
Last Name:EBRAHIMI
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1355 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3212
Mailing Address - Country:US
Mailing Address - Phone:678-486-5500
Mailing Address - Fax:678-486-5502
Practice Address - Street 1:144 BILL CARRUTH PKWY
Practice Address - Street 2:SUITE 3600
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141
Practice Address - Country:US
Practice Address - Phone:678-486-5500
Practice Address - Fax:678-486-5502
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2018-09-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002651363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA754506157Medicaid