Provider Demographics
NPI:1568420081
Name:RAHMAN, SYED TANVIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:TANVIR
Last Name:RAHMAN
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 1:1222 STATE ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5334
Mailing Address - Country:US
Mailing Address - Phone:404-885-9947
Mailing Address - Fax:
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 440
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1731
Practice Address - Country:US
Practice Address - Phone:404-296-1130
Practice Address - Fax:404-296-1132
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047506207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000836481EMedicaid
GA00836481DMedicaid
H03823Medicare UPIN
GA000836481EMedicaid
11BDTBNMedicare ID - Type Unspecified