Healthcare Provider Details

I. General information

NPI: 1497672737
Provider Name (Legal Business Name): IQRA MARYAM M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

3753 AUSTELL RD APT 4305
AUSTELL GA
30106-2236
US

V. Phone/Fax

Practice location:
  • Phone: 470-267-2000
  • Fax: 470-986-7056
Mailing address:
  • Phone: 347-264-5424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number114017
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: