Provider Demographics
NPI:1821293366
Name:TEHRANI, HAMID V (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:V
Last Name:TEHRANI
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 1:5955 JIMMY CARTER BLVD STE 40
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4608
Mailing Address - Country:US
Mailing Address - Phone:404-410-1001
Mailing Address - Fax:
Practice Address - Street 1:5955 JIMMY CARTER BLVD STE 40
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4608
Practice Address - Country:US
Practice Address - Phone:404-410-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101244271207R00000X
NY244551-1208M00000X
GA71029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821293366Medicaid
NY02887350Medicaid
NYRB5160Medicare PIN
VA1821293366Medicaid
NYRB7670Medicare PIN