Provider Demographics
NPI:1649382060
Name:DARRADJI, MOUNIR (MD)
Entity type:Individual
Prefix:
First Name:MOUNIR
Middle Name:
Last Name:DARRADJI
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 1:1019 WINDING RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-3949
Mailing Address - Country:US
Mailing Address - Phone:770-888-2524
Mailing Address - Fax:
Practice Address - Street 1:1019 WINDING RIDGE CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-3949
Practice Address - Country:US
Practice Address - Phone:770-888-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA48998207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110228627OtherMEDICARE RAILROAD
GA000913371AMedicaid
GA000913371AMedicaid