Healthcare Provider Details

I. General information

NPI: 1710997069
Provider Name (Legal Business Name): AYMAN MOHSEN FAREED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 12/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT SINAI DR
DAHLONEGA GA
30533-2367
US

IV. Provider business mailing address

330 MOUNT SINAI DR
DAHLONEGA GA
30533-2367
US

V. Phone/Fax

Practice location:
  • Phone: 706-482-2040
  • Fax:
Mailing address:
  • Phone: 706-482-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number58740
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: