Provider Demographics
NPI:1720087018
Name:SHIRAZI, SYED HAIDER (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:HAIDER
Last Name:SHIRAZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SIGMAN ROAD, NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3819
Mailing Address - Country:US
Mailing Address - Phone:770-483-9330
Mailing Address - Fax:770-483-3731
Practice Address - Street 1:1301 SIGMAN ROAD, NE
Practice Address - Street 2:SUITE 200
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3819
Practice Address - Country:US
Practice Address - Phone:770-483-9330
Practice Address - Fax:770-483-3731
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018740207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I060059Medicare PIN
GA000118709SMedicaid
GAD30809Medicare UPIN