Healthcare Provider Details

I. General information

NPI: 1306823455
Provider Name (Legal Business Name): S.Y.A.H.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 JESSE JEWELL PKWY SE SUITE 400
GAINESVILLE GA
30501-3871
US

IV. Provider business mailing address

1250 JESSE JEWEL PKWY SUITE 400
GAINESVILLE GA
30501-3871
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-0800
  • Fax: 770-532-0801
Mailing address:
  • Phone: 770-532-0800
  • Fax: 770-532-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: DR. AYHAM YOUSEF HADDAD
Title or Position: OWNER
Credential: MD
Phone: 770-532-0800