Provider Demographics
NPI: | 1821359019 |
---|---|
Name: | ESHTEHARDI, PARHAM (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | PARHAM |
Middle Name: | |
Last Name: | ESHTEHARDI |
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: | NORTHSIDE HOSPITAL - MANAGED CARE DEPT |
Mailing Address - Street 2: | 1000 JOHNSON FERRY RD NE |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30342-1606 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 404-300-2476 |
Mailing Address - Fax: | 404-250-8010 |
Practice Address - Street 1: | 201 HOSPITAL RD |
Practice Address - Street 2: | |
Practice Address - City: | CANTON |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30114-2408 |
Practice Address - Country: | US |
Practice Address - Phone: | 770-720-5100 |
Practice Address - Fax: | 404-851-6325 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-06-04 |
Last Update Date: | 2022-03-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 74220 | 207RC0000X, 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
GA | 003170184A | Medicaid | |
GA | 003170184A | Medicaid |