Provider Demographics
NPI:1831185388
Name:TEHRANI, NASSER S (MD)
Entity type:Individual
Prefix:DR
First Name:NASSER
Middle Name:S
Last Name:TEHRANI
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 1:1117 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2905
Mailing Address - Country:US
Mailing Address - Phone:478-224-1976
Mailing Address - Fax:478-224-1996
Practice Address - Street 1:1117 MORNINGSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2905
Practice Address - Country:US
Practice Address - Phone:478-224-1976
Practice Address - Fax:478-224-1996
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053044207RC0000X
GA53044207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070926198EMedicaid
GA070926198AMedicaid
GA06BDHZMMedicare PIN
GAG64387Medicare UPIN
GA070926198AMedicaid