Healthcare Provider Details

I. General information

NPI: 1295118412
Provider Name (Legal Business Name): FARJAD SIDDIQUI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 10/09/2023
Certification Date: 10/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EMORY UNIVERSITY SCHOOL OF MEDICINE, 1365 CLIFTON ROAD BLDG B, 6TH FLOOR
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

EMORY UNIVERSITY SCHOOL OF MEDICINE, 1365 CLIFTON ROAD BLDG B, 6TH FLOOR
ATLANTA GA
30322-0001
US

V. Phone/Fax

Practice location:
  • Phone: 855-366-7989
  • Fax: 404-712-2617
Mailing address:
  • Phone: 855-366-7989
  • Fax: 404-712-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number35.138401
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number96721
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number35.138401
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: