Basic Information
Provider Information | |||||||||
NPI: | 1598104549 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GARCIA | ||||||||
FirstName: | NATALIE | ||||||||
MiddleName: | ROUKHSANEH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SABZGHABAEI | ||||||||
OtherFirstName: | NATALIE | ||||||||
OtherMiddleName: | ROUKHSANEH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2484 ELLIJAY DR NE | ||||||||
Address2: |   | ||||||||
City: | BROOKHAVEN | ||||||||
State: | GA | ||||||||
PostalCode: | 303193440 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9402313036 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1405 CLIFTON RD NE | ||||||||
Address2: |   | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303221060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4047855437 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/21/2013 | ||||||||
LastUpdateDate: | 04/28/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/28/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 4301103969 | MI | N |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 208000000X | 90852 | GA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.