Healthcare Provider Details

I. General information

NPI: 1174974398
Provider Name (Legal Business Name): ATIYA CHACHAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 203
CARROLLTON GA
30117-4454
US

IV. Provider business mailing address

157 CLINIC AVE STE 203
CARROLLTON GA
30117-4454
US

V. Phone/Fax

Practice location:
  • Phone: 770-832-0429
  • Fax: 770-838-9108
Mailing address:
  • Phone: 770-832-0429
  • Fax: 770-838-9108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number90568
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90568
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116032470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: