Tom M Fazlollah, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN047276 Issued in GA

Practice address

1000 Johnson Ferry Rd NE
Atlanta, GA 30342-1606

Phone

(770) 645-9181

Fax

(770) 645-8455

NPI assigned

Sep 27, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

Practice roles

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

• Northside Anesthesiology Consultants, LLC

  • Anesthesiology Physician
  • Atlanta, GA
  • NPI 1083600308
  NPD (past)
• Peachtree Orthopaedic Surgery Center-North, LLC

  • Ambulatory Surgical Clinic/Center
  • Cumming, GA
  • NPI 1093389421
  NPD (past)

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942296660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MANSELL CT E",
            "address_2": "ATTN: CREDENTIALING DEPT., SUITE 105",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300764856",
            "telephone_number": "770-645-9181",
            "fax_number": "770-645-8455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "770-645-9181",
            "fax_number": "770-645-8455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZLOLLAH",
        "first_name": "TOM",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN047276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Faya, MD
• Fayette Community Anesthesia
• Amara Zulfiqar Fazal, MD
• Abia Fazili
• Irtiqa Farooq Fazili, MD
• FC Midlands N Charleston, LLC
• FCN Medical Group
• FDH - Atlanta LLC
• Frank Feagin
• Lavesta Monique Feagin, BCBA

• Certified Registered Nurse Anesthetist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.