Provider Demographics
NPI:1053880500
Name:ZOHREH, SEPIDEH (RDN)
Entity type:Individual
Prefix:MS
First Name:SEPIDEH
Middle Name:
Last Name:ZOHREH
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:SEPIDEH
Other - Middle Name:
Other - Last Name:NIKGOHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:9835 AUTRY FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8095
Mailing Address - Country:US
Mailing Address - Phone:602-810-4690
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD005165133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALD005165OtherDIETITIAN LICENSE