Healthcare Provider Details

I. General information

NPI: 1336050806
Provider Name (Legal Business Name): ARSLAN TARIQ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3290 SIXES RD
CANTON GA
30114-9102
US

IV. Provider business mailing address

PO BOX 746765
ATLANTA GA
30374-6765
US

V. Phone/Fax

Practice location:
  • Phone: 770-268-4053
  • Fax: 470-251-6003
Mailing address:
  • Phone: 770-914-0116
  • Fax: 770-955-4278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP332736
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: