Provider Demographics
NPI:1649267329
Name:DAFTARI, TAPAN K (MD)
Entity type:Individual
Prefix:DR
First Name:TAPAN
Middle Name:K
Last Name:DAFTARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2041 MESA VALLEY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8157
Mailing Address - Country:US
Mailing Address - Phone:770-944-1100
Mailing Address - Fax:770-944-6469
Practice Address - Street 1:2041 MESA VALLEY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8157
Practice Address - Country:US
Practice Address - Phone:770-944-1100
Practice Address - Fax:770-944-6469
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA032541207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000660118HMedicaid
GA000660118KMedicaid
GA000660118GMedicaid
GA000660118IMedicaid
GA000660118GMedicaid
GA000660118IMedicaid