Provider Demographics
NPI:1215929161
Name:HAMIDI, HALEH P (MD)
Entity type:Individual
Prefix:DR
First Name:HALEH
Middle Name:P
Last Name:HAMIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HALEH
Other - Middle Name:
Other - Last Name:POURHAMIDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1700 TREE LANE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6782
Mailing Address - Country:US
Mailing Address - Phone:770-972-0330
Mailing Address - Fax:770-985-2683
Practice Address - Street 1:1700 TREE LANE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6782
Practice Address - Country:US
Practice Address - Phone:770-972-0330
Practice Address - Fax:770-985-2683
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049022207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00899445AMedicaid
GAH-47380Medicare UPIN
GA16BDVDLMedicare ID - Type Unspecified