Provider Demographics
NPI:1821479981
Name:FARAHMAND, FIROOZEH (MDPHD)
Entity Type:Individual
Prefix:
First Name:FIROOZEH
Middle Name:
Last Name:FARAHMAND
Suffix:
Gender:F
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#7672-1072 W PEACHTREE ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1072 PEACHTREE ST. W
Practice Address - Street 2:#7672
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:434-282-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2016-03-30
Deactivation Date:2016-01-25
Deactivation Code:
Reactivation Date:2016-03-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program