Basic Information
| Provider Information | |||||||||
| NPI: | 1033164256 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YAZDANPANAH | ||||||||
| FirstName: | ASHKAN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 531 ROSELANE STREET NW | ||||||||
| Address2: | SUITE 830 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707940477 | ||||||||
| FaxNumber: | 7707943108 | ||||||||
| Practice Location | |||||||||
| Address1: | 677 CHURCH ST NE | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300601101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707940477 | ||||||||
| FaxNumber: | 7707943108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 055464 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207LP3000X | 055464 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pediatric Anesthesiology | 207L00000X | 055464 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 055464 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 055464 | GA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 444004410C | 05 | GA | MEDICAID | 444004410E | 05 | GA | MEDICAID | 444004410B | 05 | GA | MEDICAID | 444004410A | 05 | GA | MEDICAID | 444004410D | 05 | GA | MEDICAID | 444004410F | 05 | GA | MEDICAID |