Healthcare Provider Details

I. General information

NPI: 1780154914
Provider Name (Legal Business Name): SYAH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 PARKWAY PLAZA
CLEVELAND GA
30528
US

IV. Provider business mailing address

1250 JESSE JEWELL PKWY SE STE 300
GAINESVILLE GA
30501-3865
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-0800
  • Fax:
Mailing address:
  • Phone: 770-532-0800
  • Fax: 770-532-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANCY ALLEN
Title or Position: BILLING MANAGER
Credential:
Phone: 770-532-0800