Healthcare Provider Details

I. General information

NPI: 1598314635
Provider Name (Legal Business Name): FARAIBA FAQEERZADA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 MARKET ST STE E1
CLARKSTON GA
30021-2653
US

IV. Provider business mailing address

3700 MARKET ST STE E1
CLARKSTON GA
30021-2653
US

V. Phone/Fax

Practice location:
  • Phone: 678-383-1383
  • Fax:
Mailing address:
  • Phone: 678-383-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: