| Doctor Name: | DR. MOHAMMAD MEHDI MOMTAHAN |
| NPI Number: | 1225271422 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | NCC 210724 |
| Business Practice Address: | 59 Hillside Trace Suite 113 Dallas, GA - 301573315 |
| Business Phone Number: | 7704431644 |
| Business Fax Number: | 7704431633 |
| Mailing Address: | 59 Hillside Trce, Suite 113 DALLAS |
| State: | GA |
| Postal Code: | 301579476 |
| Phone Number: | 7704431644 |
| Fax Number: | 7704431633 |
| NPI Enumeration Date: | 04/17/2009 |
| NPI Last Update Date: | 01/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | NCC 210724 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |