Healthcare Provider Details

I. General information

NPI: 1710373816
Provider Name (Legal Business Name): MUHAMMAD USMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 FRIENDSHIP RD
BRASELTON GA
30517-5622
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-5211
US

V. Phone/Fax

Practice location:
  • Phone: 783-416-3506
  • Fax:
Mailing address:
  • Phone: 770-442-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86612
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number295164
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: