Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | PA184727 | OR |
NPI | 1053835793 |
---|---|
Provider Name | Joseph John Esfahbodi Rad |
First Address | Atlanta, GA 30329-3465 |
Second Address | Decatur, GA 30033-5918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 03/01/2022 |