Basic Information
| Provider Information | |||||||||
| NPI: | 1720087018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHIRAZI | ||||||||
| FirstName: | SYED | ||||||||
| MiddleName: | HAIDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 SIGMAN ROAD, NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704839330 | ||||||||
| FaxNumber: | 7704833731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 SIGMAN ROAD, NE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704839330 | ||||||||
| FaxNumber: | 7704833731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 018740 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.