Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 51539 | GA |
N | 111NI0900X | Internist | 51539 | GA |
Y | 207R00000X | Internist | ME113682 | FL |
Y | 111NI0900X | Internist | ME113682 | FL |
N | 207RI0200X | Infectious Disease | 51539 | GA |
NPI | 1063457059 |
---|---|
Provider Name | Amir Behzad Razavi |
First Address | Griffin, GA 30224-4213 |
Second Address | Miramar Beach, FL 32550-4890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 06/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000953147B | (05) | GA |
009993180 | (05) | AL |
52893951-003 | BLUE CROSS/BLUE SHIELD (01) | GA |
H61328 | (02) |