Provider Demographics
NPI:1538301718
Name:REDJAMAND, MOJGAN (NP)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:REDJAMAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 HOSPITAL SOUTH DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6810
Mailing Address - Country:US
Mailing Address - Phone:678-741-2317
Mailing Address - Fax:678-741-2301
Practice Address - Street 1:1700 HOSPITAL SOUTH DR
Practice Address - Street 2:SUITE 410
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6810
Practice Address - Country:US
Practice Address - Phone:678-741-2317
Practice Address - Fax:678-741-2301
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160834NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I508336OtherMEDICARE PTAN 202I508336
GA847967037AMedicaid
GA202I508336OtherMEDICARE PTAN 202I508336