Provider Demographics
NPI:1659341303
Name:BEJANISHVILI, SABA V (MD)
Entity Type:Individual
Prefix:DR
First Name:SABA
Middle Name:V
Last Name:BEJANISHVILI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:STE 204
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-819-1717
Mailing Address - Fax:770-819-1140
Practice Address - Street 1:4460 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1844
Practice Address - Country:US
Practice Address - Phone:770-941-4716
Practice Address - Fax:770-941-3047
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0521432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA432250739CMedicaid
P00218408OtherRR MEDICARE
P00218408OtherRR MEDICARE
GA1659341303Medicare PIN