Healthcare Provider Details

I. General information

NPI: 1275638140
Provider Name (Legal Business Name): ALIYA GHANI ZIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 W MAIN ST
MESA AZ
85201-6920
US

IV. Provider business mailing address

562 CONCORD RD SE
SMYRNA GA
30082-2608
US

V. Phone/Fax

Practice location:
  • Phone: 877-809-5092
  • Fax: 480-840-1834
Mailing address:
  • Phone: 770-384-9900
  • Fax: 770-384-9912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA83657
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number78256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: