Provider Demographics
NPI:1780767335
Name:SADRI, SAEIDEH L (DC)
Entity type:Individual
Prefix:DR
First Name:SAEIDEH
Middle Name:L
Last Name:SADRI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 THOMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3322
Mailing Address - Country:US
Mailing Address - Phone:404-765-0595
Mailing Address - Fax:404-765-9784
Practice Address - Street 1:1668 THOMPSON AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3322
Practice Address - Country:US
Practice Address - Phone:404-765-0595
Practice Address - Fax:404-765-9784
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR005729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00759679AMedicaid
GAP5412490OtherAETNA HMO
GAH1006049OtherAETNA PPO
GA52448960OtherBCBS
GAH1006049OtherAETNA PPO
GAU66804Medicare UPIN