Provider Demographics
NPI:1629209176
Name:FOROUZANDEH, FARSHAD (MD, PHD)
Entity type:Individual
Prefix:
First Name:FARSHAD
Middle Name:
Last Name:FOROUZANDEH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOODRUFF CIR
Mailing Address - Street 2:WMB 308
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-727-4724
Mailing Address - Fax:404-712-8335
Practice Address - Street 1:6525 POWERS BLVD STE 301
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5461
Practice Address - Country:US
Practice Address - Phone:440-882-0075
Practice Address - Fax:440-882-0080
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPERMIT#005402390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program