Healthcare Provider Details

I. General information

NPI: 1487736138
Provider Name (Legal Business Name): NORTH ATLANTA FAMILY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

IV. Provider business mailing address

1400 NORTHSIDE FORSYTH DR STE 240
CUMMING GA
30041-6017
US

V. Phone/Fax

Practice location:
  • Phone: 770-844-0877
  • Fax: 770-844-0891
Mailing address:
  • Phone: 770-844-0877
  • Fax: 770-844-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SOHEL MOMIN
Title or Position: AO
Credential: MD
Phone: 770-844-0877