Provider Demographics
NPI:1700903135
Name:ZARIAN-DERO, MEHRAB JONATHON (PA)
Entity Type:Individual
Prefix:MR
First Name:MEHRAB
Middle Name:JONATHON
Last Name:ZARIAN-DERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 ROCK SPRINGS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5101
Mailing Address - Country:US
Mailing Address - Phone:404-875-6288
Mailing Address - Fax:
Practice Address - Street 1:5775 JIMMY CARTER BLVD
Practice Address - Street 2:#200
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2989
Practice Address - Country:US
Practice Address - Phone:678-646-3627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002434363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical