Provider Demographics
NPI:1194803445
Name:FATEMI, AREZOU (MD)
Entity type:Individual
Prefix:
First Name:AREZOU
Middle Name:
Last Name:FATEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 N POINT PKWY
Mailing Address - Street 2:STE 303
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4522
Mailing Address - Country:US
Mailing Address - Phone:678-205-9004
Mailing Address - Fax:678-205-9005
Practice Address - Street 1:3180 N POINT PKWY
Practice Address - Street 2:STE 303
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4522
Practice Address - Country:US
Practice Address - Phone:678-205-9004
Practice Address - Fax:678-205-9005
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCFVQMedicare ID - Type Unspecified
GAH55723Medicare UPIN