Healthcare Provider Details

I. General information

NPI: 1720423916
Provider Name (Legal Business Name): TANIA QADIR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4184 HANNAHS XING
EVANS GA
30809-8010
US

IV. Provider business mailing address

4184 HANNAHS XING
EVANS GA
30809-8010
US

V. Phone/Fax

Practice location:
  • Phone: 845-427-1223
  • Fax:
Mailing address:
  • Phone: 845-427-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License Number83292
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number91308
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number58.004879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: