Healthcare Provider Details

I. General information

NPI: 1770895419
Provider Name (Legal Business Name): FAHD KHALID SYED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2032 WYNNTON RD SUITE A
COLUMBUS GA
31906-2448
US

IV. Provider business mailing address

2032 WYNNTON RD SUITE A
COLUMBUS GA
31906-2448
US

V. Phone/Fax

Practice location:
  • Phone: 706-322-8820
  • Fax: 706-322-8850
Mailing address:
  • Phone: 706-322-8820
  • Fax: 706-322-8850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number243920
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number72823
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number72823
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: