Individual provider Active NPI

Ashkan Yazdanpanah, DO

  • Anesthesiology Physician
  • Marietta, GA
National Provider Identifier
1033164256
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
055464 Issued in GA
Practice address
677 Church St NE
Marietta, GA 30060-1101
Phone
(770) 794-0477
Fax
(770) 794-3108
NPI assigned
May 24, 2006
Last updated
Aug 29, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 055464 GA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 055464 GA
Pain Medicine Physician 208VP0000X 055464 GA
Interventional Pain Medicine Physician 208VP0014X 055464 GA
Pediatric Anesthesiology Physician 207LP3000X 055464 GA

Addresses

Primary practice location

677 Church St NE
Marietta, GA 30060-1101

Mailing address

531 Roselane Street NW
Suite 830
Marietta, GA 30060
Phone (770) 794-0477

Other practice location 1

531 Roselane Street NW
Suite 830
Marietta, GA 30060
Phone (770) 794-0477

Other practice location 2

8954 Hospital Dr
Douglasville, GA 30134-2272
Phone (770) 794-0477

Other practice location 3

146 Bill Carruth Pkwy
Hiram, GA 30141-3749
Phone (770) 794-0477

Other practice location 4

2540 Windy Hill Rd SE
Marietta, GA 30067-8605
Phone (770) 794-0477

Other identifiers 6

IdentifierTypeStateIssuer
444004410DMedicaidGA
444004410BMedicaidGA
444004410EMedicaidGA
444004410AMedicaidGA
444004410CMedicaidGA
444004410FMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051011000480 GA Practitioner - Anesthesiology 5597780379 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2001
Medicare assignment
May accept Medicare assignment
Group practices
Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians
Mak Anesthesia Holdings, LLCGroup PAC ID 4284917204, 370 clinicians

Practice addresses (Care Compare)

2518 Jimmy Lee Smith Pkwy
Hiram, GA 30141-2068
Phone (770) 732-4022

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 702-1806

5150 Stilesboro N W Rd
Suite 220
Kennesaw, GA 30152-7742
Phone (770) 424-8222

625 Church Nest
Marietta, GA 30060-1101
Phone (770) 422-2004

677 Church Nest
Marietta, GA 30060-1101

677 Church St NE
Suite 100P
Marietta, GA 30060-1101
Phone (470) 793-8585

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
055464GAMDInterventional Pain Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wellstar Medical Group, LLC CurrentSince Jul 1, 2022 Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients
Concordia Anesthesiology, Inc Anesthesiology CurrentSince Jun 1, 2023 Accepting new patients
Paulding Anesthesia Associates, PC Anesthesiology Past Accepting new patients
Monroe Hma, LLC Interventional Pain Medicine Past Accepting new patients
Parkway Anesthesia Consultants, PC Anesthesiology Past Accepting new patients
Monroe Hma Inc Past Accepting new patients
TMC-West Georgia Anesthesia Associates Inc. Anesthesiology Past Accepting new patients
Monroe Hma Physician Management LLC Past Accepting new patients

Locations

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

600 W Memorial Dr
Dallas, GA 30132
Phone (770) 443-7072

8954 Hospital Dr
Douglasville, GA 30134
Phone (678) 838-2584

146 Bill Carruth Pkwy
Hiram, GA 30141
Phone (770) 443-4775

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

2540 Windy Hill Rd SE
Marietta, GA 30067
Phone (470) 644-1274

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

805 Sandy Plains Rd
Marietta, GA 30066
Phone (770) 792-1616

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

11650 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 543-8132

3000 Hospital Blvd
Roswell, GA 30076
Phone (770) 751-2500

218 Sandy Springs Pl
Sandy Springs, GA 30328
Phone (404) 257-0611

5730 Glenridge Dr
Ste T150
Sandy Springs, GA 30328
Phone (404) 256-5428

601 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 456-3000

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1033164256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 ROSELANE STREET NW",
            "address_2": "SUITE 830",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "531 Roselane Street NW",
            "address_2": "Suite 830",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "30060",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8954 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301342272",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "146 Bill Carruth Pkwy",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301413749",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2540 Windy Hill Rd SE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300678605",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YAZDANPANAH",
        "first_name": "ASHKAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "GA",
            "license": "055464",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "GA",
            "license": "055464",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "055464",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "055464",
            "primary": false
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "GA",
            "license": "055464",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "444004410F",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.