Healthcare Provider Details

I. General information

NPI: 1346105962
Provider Name (Legal Business Name): RIDA NAEEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3031
US

IV. Provider business mailing address

164 HARMONY GROVE RD
LILBURN GA
30047-6264
US

V. Phone/Fax

Practice location:
  • Phone: 404-922-9097
  • Fax:
Mailing address:
  • Phone: 404-922-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number059632750
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: