Provider Demographics
NPI:1053903062
Name:BAKHTIARYDAVIJANI, AMIRHOSHANG
Entity type:Individual
Prefix:DR
First Name:AMIRHOSHANG
Middle Name:
Last Name:BAKHTIARYDAVIJANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2742 SAINT AUGUSTINE TRL SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-6264
Mailing Address - Country:US
Mailing Address - Phone:404-626-2582
Mailing Address - Fax:
Practice Address - Street 1:2742 SAINT AUGUSTINE TRL SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-6264
Practice Address - Country:US
Practice Address - Phone:404-626-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist