Provider Demographics
NPI:1225329139
Name:GHANBARI, FARAMARZ (NP)
Entity type:Individual
Prefix:
First Name:FARAMARZ
Middle Name:
Last Name:GHANBARI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 WESTFIELD PL
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-5144
Mailing Address - Country:US
Mailing Address - Phone:423-651-0300
Mailing Address - Fax:423-651-0017
Practice Address - Street 1:503 WESTFIELD PL
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-5144
Practice Address - Country:US
Practice Address - Phone:423-651-0300
Practice Address - Fax:423-651-0017
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015645363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily