Provider Demographics
NPI:1942681754
Name:MAHZOON, SAHAR (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAHAR
Middle Name:
Last Name:MAHZOON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 COOK ST
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-3932
Mailing Address - Country:US
Mailing Address - Phone:762-444-6035
Mailing Address - Fax:762-444-6738
Practice Address - Street 1:625 COOK ST
Practice Address - Street 2:
Practice Address - City:ROYSTON
Practice Address - State:GA
Practice Address - Zip Code:30662-3932
Practice Address - Country:US
Practice Address - Phone:762-444-6035
Practice Address - Fax:762-444-6738
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001401213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist