Provider Demographics
NPI:1730144569
Name:SHARIFI, ANISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 HILLANDALE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4103
Mailing Address - Country:US
Mailing Address - Phone:770-670-6100
Mailing Address - Fax:678-990-1446
Practice Address - Street 1:5700 HILLANDALE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-4103
Practice Address - Country:US
Practice Address - Phone:770-670-6100
Practice Address - Fax:678-990-1446
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032654208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000437214DMedicaid