Provider Demographics
NPI:1710974555
Name:KHANSARINIA, SAEID (MD)
Entity Type:Individual
Prefix:
First Name:SAEID
Middle Name:
Last Name:KHANSARINIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 5015
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-603-9100
Mailing Address - Fax:404-603-9155
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 5015
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-603-9100
Practice Address - Fax:404-603-9155
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA50649208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA720327080BCMedicaid
GA202I337040Medicare PIN
GA720327080BCMedicaid