Healthcare Provider Details

I. General information

NPI: 1245420082
Provider Name (Legal Business Name): NAUREEN MUNAWAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030-4194
US

IV. Provider business mailing address

445 WINN WAY
DECATUR GA
30030-4194
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7796
  • Fax:
Mailing address:
  • Phone: 404-508-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number67513
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: