Provider Demographics
NPI:1255527339
Name:YAZDANPANAH, WAHID (MD)
Entity type:Individual
Prefix:
First Name:WAHID
Middle Name:
Last Name:YAZDANPANAH
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 1:1660 MULKEY RD. SUITE B
Mailing Address - Street 2:COBB NEPHROLOGY HYPERTENSION ASSOCIATES
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:678-460-2700
Mailing Address - Fax:
Practice Address - Street 1:1660 MULKEY RD STE B
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1105
Practice Address - Country:US
Practice Address - Phone:678-460-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059794207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA869171884AMedicaid
GA11SCHSHMedicare PIN